Osteochondritis dissecans of the talar dome in a collegiate swimmer: a case report.
OBJECTIVE
To present the case of an intercollegiate swimmer with a stage IV lateral talar dome injury and associated bony fragments.


BACKGROUND
Lack of distinct diagnostic symptoms, low index of clinical suspicion, and the difficulty of visualizing the early stages of this injury on standard x-rays cause frequent misdiagnosis of talar dome lesions.


METHODS
Ganglion cyst, with inflammatory synovitis secondary to rupture of cyst; loose bodies from previous occult fracture; osteochondral fracture.


METHODS
Initial treatment with nonsteroidal antiinflammatory drugs and a posterior splint for comfort, followed by arthroscopic excision of loose bodies with abrasion and drilling arthroplasty.


RESULTS
Patient presented to the team physician for care of acute left medial ankle pain after the athletic trainer had attempted to rupture a ganglion cyst on the anterolateral aspect of the patient's ankle.


CONCLUSIONS
Increased clinical suspicion is necessary to correctly diagnose osteochondral lesions, particularly in the early stages. Aggressive treatment of talar dome lesions has a good success rate and may be an attractive option for competitive athletes.
University of California at Berkeley, Berkeley, CA 94720-4300.
M
M
Smith
C J
CJ
Chang