Osteochondritis dissecans of the talus

Case contributed by Ioannis Tsamis

Presentation

A young footballer is investigated after an injury in a local match. The patient is complaining about pain in the ankle joint centrally, and medially.

Patient Data

Age: 20 years
Gender: Male

A small crater is located medially on the convex surface of the talus, next to the internal malleolus. A small (up to 1.1 cm long) osseous fragment is seen placed inside the crater, separated from the underlying bone. Both the lesions appear with sclerotic margins and a smooth contour (the latter slightly microlobulated regarding the osseous fragment). 

Very small subchondral cysts accompany the perimeter of the crater. A second swallow indentation can be seen at the anterior upper aspect of the talus, also indicating chronic micro-injuries. 

No other visible sign of fracture was revealed in the study above. 

The findings are consistent with osteochondritis dissecans of the talus, stage III (complete separation, no displacement). 

Annotated 3D Image: The red lines show the contour of the crater. The black line indicates the osseous fragment. 

All images are courtesy of Dr Ioannis Vasilakis, MD PhD, Radiology (GRE)

Case Discussion

The diagnosis of osteochondritis dissecans is in very good alignment with the epidemiological data: age (20 years), gender (male), and occupation (footballer). 

The sclerotic rim of the lesions described above is more suggestive of a chronic entity than an acute one, based on the recent sports injury. Besides, there is a mismatch between the referred aspect of the recent injury and the location of the pain, as referred by the patient. 

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