Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Cartilage Injury of the Talus Dome

SYMPTOMS

The patient presents with stiffness, diffuse exercise-induced aching or occasional sharp pain, clicking, locking and effusion of the ankle joint, most often after a severe previous sprain or recurrent instability.

AETIOLOGY

The aetiology is direct or indirect trauma to the talus dome cartilage, often occurring in contact sports like soccer and rugby. This is the most common cause for ankle pain persisting for more than three weeks after an ankle sprain.

CLINICAL FINDINGS

There is effusion and tenderness on palpation over the talus dome. Plantar flexion provides better access to the dome. Sometimes the anterior impingement test is positive. Occasionally there is combined pain and instability of the ankle joint after a previous sprain that makes the diagnosis difficult. Instability from insufficient lateral ligaments seldom causes pain, however when the syndesmosis ligament is damaged pain can be the predominant symptom.

INVESTIGATIONS

X-ray is often normal. MRI may show sub-chondral oedema and effusion in the joint but cartilage injuries are often missed on MRI. When there is a bony component (osteochondral injury) MRI often underestimates the extent of the injury.

TREATMENT

NSAID can give short-term relief but arthroscopy is usually indicated and curative. Loose bodies are excised, cartilage defects are trimmed and underlying bone is sometimes micro-fractured. Direct weight bearing is usually allowed.

REFERRALS

Refer to podiatrist and physiotherapist for mild symptoms and to orthopaedic ankle surgeon if symptoms are severe or when there is persistent pain, effusion and the above signs more than one month after a severe ankle sprain.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes and avoiding impact. If there is pain on impact suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

OCD, which has a typical appearance on MRI but is treated in the same manner, with arthroscopy.

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