PMC7596014_01
Photograph showing swelling over the proximal posterior aspect of the medial malleolus.
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There was tenderness and swelling over the ankle joint and the proximal posterior aspect of the medial malleolus (Fig. 1).
Preoperative plain radiography images. Images showing severe tibiotalar joint space narrowing, indicating osteoarthritic change in the standing position on (a) anterior-posterior view and (b) lateral view.
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Plain radiographs revealed severe joint space narrowing between the tibia and talus, indicating osteoarthritic change in the left ankle in the standing position on anterior-posterior view (Fig. 2a) and lateral view (Fig. 2b).
Preoperative computed tomography (CT) images. CT shows osteophyte of the posteromedial aspect of the distal tibia (arrow) on (a) coronal view and (b) axial view and on (c) 3D CT imaging.
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Computed tomography (CT) images showed an osteophyte of the posteromedial aspect of the distal tibia on coronal view (Fig. 3a) and axial view (Fig. 3b) and on three-dimensional (3D) CT imaging (Fig. 3c).
Preoperative magnetic resonance imaging (MRI) findings. MRI shows osteophyte impinging on the tibial nerve (arrow) on (a) T1-weighted, (b) T2-weighted, and (c) short T1 inversion recovery (STIR) images on coronal view, and on (d) T2 and (e) STIR images on axial view.
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Magnetic resonance (MR) images showed the osteophyte impinging on the tibial nerve on T1-weighted (Fig. 4a), T2-weighted (Fig. 4b), and short T1 inversion recovery (STIR) images (Fig. 4c) on coronal view, and on T2 (Fig. 4d) and STIR (Fig. 4e) images on axial view.
Operative arthroscopy findings. (a) Fibrous tissue is seen filling the ankle joint space. (b) Cartilage is almost gone and subchondral bone is exposed at the articular surface of the tibial plafond and talar trochlea. (c) Using a surgical abrader, all remaining articular cartilage is denuded and beds of bleeding cancellous bone are established.
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Fibrous tissue was seen filling the ankle joint space (Fig. 5a) and synovitis was severe. Cartilage was almost completely denuded and subchondral bone was exposed at the articular surface of the tibial plafond and talar trochlea (Fig. 5b). Using a surgical abrader, we denuded all remaining articular cartilage and established beds of bleeding cancellous bone (Fig. 5c).
Intraoperative photograph. (a) Osteophyte of the posteromedial aspect of the distal tibia (arrow) is seen impinging on the medial plantar nerve (arrowhead). (b) The osteophyte is excised (arrow) and the tibial nerve released (arrowhead).
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After fixation, the flexor retinaculum was released, exposing the osteophyte in the posteromedial side of the distal tibia pushing the tibial nerve from the anterior aspect (Fig. 6a). The osteophyte was removed (Fig. 6b).
Postoperative computed tomography (CT) images. Osteophyte removal (arrow) on (a) axial, (b) coronal, and (c) 3-DCT images.
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CT images soon after surgery confirmed successful removal of the osteophyte on coronal view (Fig. 7a) and axial view (Fig. 7b) and on a 3D CT image (Fig. 7c).
Radiographs 2 years after surgery. Bony union was achieved, seen in the standing position on (a) anteroposterior view and (b) lateral view.
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She was not taking any medication, as radiographs showed complete union between the tibia and the talus on weightbearing on antero-posterior view (Fig. 8a) and lateral view (Fig. 8b).
Photograph 2 years after surgery. No swelling is seen over the ankle joint or the proximal posterior aspect of the medial malleolus.
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There was no tenderness or swelling over the ankle joint or the proximal posterior level of the medial malleolus (Fig. 9).