Case 3, presented by Mark C. Drakos, MD and Austin T. Fragomen, MD describes a 27-year-old female who presented to HSS for evaluation of her left ankle in 2013, reporting a long-standing history of left ankle problems. She had undergone a foot and ankle reconstruction in May of 2011 performed by an outside physician. In spite of treatment with various braces and orthotics, the patient reported that the condition was getting progressively worse. After examination at HSS, surgical management was recommended beginning with ankle arthroscopy and cartilage repair using denovo allograft with bone marrow aspirate concentrate from the patient’s iliac crest. In addition, a supramalleolar osteotomy with ankle distraction was suggested with a Taylor spatial frame. Staging a lateral ligament reconstruction with hamstring autograft, revision calcaneal osteotomy and posterior tibial lengthening to address the adduction deformity was also recommended. The patient was initially treated in a cast and then advanced to a CAM boot with partial weight bearing at 2 months, followed by a Ritchie Brace at 4 months. She was able to walk without any assistive devices by 6 months.
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