Novel Surgical Approach for Large Intraosseous Subchondral Cysts of Talus: A Case Report and Technical Innovation

Large subchondral bone cysts in the medial talar body and dome are common and can cause persistent pain and swelling during axial loading. Open debridement and bone grafting are often necessary to treat these lesions but can require extensive soft-tissue dissection or malleolar osteotomies. A 40-year-old woman presented with ankle pain and swelling for 1 year, worsening with activity and no history of trauma. X-rays showed a cystic lesion in the medial talar dome with no joint line disruption. CT confirmed the cystic lesion without bone collapse or expansion. An anterior approach to the ankle joint was extended to access the talar neck. A window was created in the talar neck to debride and curette the medial talar dome, and the void was filled with allograft. The patient was non-weight-bearing for 6 weeks, followed by gradual weight-bearing and ankle range of motion exercises starting on postoperative day 1. The patient returned to her pre-injury status within 3 months and was asymptomatic at the 6-year follow-up, with good bone graft integration and no symptoms. This technical note presents a novel approach to lesions of the medial talar body and dome through the talar neck, avoiding the need for malleolar osteotomy or disruption to the tibiotalar joint, and resulting in good functional outcomes.