Arthroscopic Treatment of Bone Cyst of Anterior Half of the Talar Body

Abstract

Large talar bone cyst can cause pathologic fracture and damage to the articular cartilage, resulting in persistent swelling and pain of the subtalar joint and ankle joint. For a symptomatic cyst not responding to conservative treatment, surgery can be considered. Open debridement and bone grafting frequently require extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. Arthroscopic treatment of talar bone cyst is a feasible alternative minimally invasive approach to reduce surgical trauma and eliminate the need for osteotomy. Bone cyst of the anterior part of the talar body can be debrided via a bone window of the talar neck, which is normally devoid of cartilage. The purpose of this Technical Note is to describe the technique of arthroscopic treatment of bone cyst of anterior half of the talar body. This minimally invasive approach does not disrupt the normal articular cartilage of the talar dome.

Fig 1

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. Preoperative radiographs of the illustrated case show the bone cyst at the anterior half of the talar body. (A) Anteroposterior view; (B) lateral view. (BC, bone cyst.)

Fig 2

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. Preoperative computed tomogram images of the illustrated case show the location of the bone cyst at the anterior half of the talar body. (A) Coronal view; (B) sagittal view. (BC, bone cyst.)

Fig 3

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. Ankle arthroscopy is performed via the anteromedial and anterolateral portals which are at the lateral side of tibialis anterior tendon and the medial side of peroneus tertius tendon respectively. (ALP, anterolateral portal; AMP, anteromedial portal; PT, peroneus tertius tendon; TA, tibialis anterior tendon.)

Fig 4

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. The anterolateral portal is the viewing portal and the anteromedial portal is the working portal. (A) The osteochondral lesion is debrided with an arthroscopic probe. (B) Microfracture of the subchondral bone is performed with an arthroscopic awl. (AA, arthroscopic awl; CF, cartilage flap; OCL, osteochondral lesion; TD, talar dome.)

Fig 5

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. The anterolateral portal is the viewing portal and the anteromedial portal is the working portal. A 1.6-mm K wire is inserted into the ankle joint via the anteromedial portal. Under fluoroscopic guidance, the K wire is inserted into the bone cyst through the talar neck. (A) Arthroscopic view; (B) anterolateral fluoroscopic view; (C) lateral fluoroscopic view. (BC, bone cyst; GW, guidewire; TN, talar neck.)

Fig 6

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. (A) The bone tract from the talar neck to the bone cyst. (B) The bone window at the talar neck is further enlarged by an arthroscopic acromionizer. (BC, bone cyst; TN, talar neck.)

Fig 7

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. The anterolateral portal is the viewing portal and the anteromedial portal is the working portal. (A) The fibrous tissue of the bone cyst is removed by an arthroscopic punch forceps. (B) arthroscopic view of the cyst wall after debridement of the bone cyst. (CW, cyst wall; FT, fibrous tissue; TN, talar neck.)

Fig 8

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. The anterolateral portal is the viewing portal and the anteromedial portal is the working portal. After complete resection of the soft tissue of the bone cyst, microfracture of the cyst wall is performed with an arthroscopic awl. (AA, arthroscopic awl; CW, cyst wall.)

Fig 9

Arthroscopic treatment of bone cyst of anterior half of the talar body of the right ankle. The patient is in supine position. It is converted into dry arthroscopy and endoscopy. The anterolateral portal is the viewing portal and the anteromedial portal is the working portal. The fluid inflow is switched off and the blood of the cyst is sucked out. (A) The PRO-DENSE injectable regenerative graft is injected into the cyst. (B) Arthroscopic view shows that the cyst is filled up with the graft. (C) Anteroposterior fluoroscopic view confirms that the cyst is filled up with the graft. (D) Lateral fluoroscopic view confirms that the cyst is filled up with the graft. (IRG, injectable regenerative graft; TD, talar dome; TN, talar neck.)