PMC6588142_01
Plain radiographs of both ankle joints (anteroposterior and lateral views) showing a cystic lesion in the right talus.
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F1
Plain radiographs showed a large cystic lesion involving whole of the body of the talus with preserved ankle and subtalar joint space and contour (Fig. 1) Computed tomography (CT) scan revealed a large unicameral bone cyst in the body of talus measuring 25 mm x 22 mm in the widest anteroposterior and mediolateral diameters, extending from and involving the superior and inferior subchondral bone.
Computed tomography images confirming the size and extent of lesion.
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F2
There was a pathological fracture in the superior subchondral bone and posterior talar process (Fig. 2).
Portal placement - standard posteromedial and posterolateral (left) and approach to cyst using a Kirschner wire under image intensifier guidance (right).
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F3
Standard posteromedial and posterolateral appoaches were used on either side of tendoachilles (Fig. 3). Approach to the cyst through the posterior talar process was localized and confirmed under image intensifier with a Kirschner wire (Fig. 3).
Cyst cavity before (left) and after (right) arthroscopic debridement.
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F4
The cyst was debrided, and the margins were curetted out (Fig. 4).
Bone graft harvest from ipsilateral calcaneum using osteochondral autograft transfer system.
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F5
Two plugs of bone were harvested and then prepared into small bits (Fig. 5).
Arthroscopy sleeve used to fill in bone graft.
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F6
Using the arthroscopy irrigation sleeve, the graft was used to fill the cyst (Fig. 6).
Post-operative radiographs - Immediate post-operative (top left); at 3 months (bottom left); at 7 months (right).
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F7
Subsequent post-operative radiographs at 3 and 7 months showed progressive regrowth of new bone (Fig. 7).
Post-operative computed tomography image at 10 months showing "healed" cyst (left) and donor site (right).
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F8
CT scan obtained at 10months revealed complete bone filling and preservation of joint space without collapse (Fig. 8).