Cartilage-sparing Arthroscopic Technique for Curettage and Bone Grafting of Cystic Lesion of Talus –A Case Report

INTRODUCTION: True cysts in talar body are extremely rare lesions and their treatment options are yet undefined. The standard of care for a large symptomatic talar bone cyst comprises debridement and bone grafting, often requiring extensive soft tissue dissection, damaging talar cartilage, and sometimes, malleolar osteotomy. Alternatively, an arthroscopic debridement of the cyst cavity with bone grafting may be performed, sparing talar cartilage. Here, we describe such a case of a talar body cyst treated successfully by arthroscopic technique. CASE REPORT: A 12-year-old boy presented with unicameral bone cyst in the body of talus, with fracture of the subchondral bone. Radiological evaluation suggested a simple bone cyst (SBC). Thereafter, posterior ankle arthroscopy was performed and the cyst was approached through posteriortalar process. Debridement of the cystic lesion was done along with curettage, sparing a thin rim of surrounding subchondral bone. The articular cartilage was found intact on both superior and inferior aspects. Subsequently, the defect was filled arthroscopically with cancellous bone graft harvested from the ipsilateral calcaneum through osteochondral autograft transfer system. CONCLUSION: Outcome of the procedure was assessed clinically as well as radiologically. The histopathological report confirmed the lesion to be a SBC. The child was asymptomatic and resumed sports in school by 6 months. The cystic lesion of talus healed completely by 8 months. According to the modified Neer classification, the lesion had ‘healed’ radiologically.