case_images: PMC5974671_01
case_images: Mortise projections of the right ankle. After persisting ankle pain, on 3-month follow- up, the radiographs were interpreted as normal with no signs of osteonecrosis (a). On 4-week post-procedure clinical follow-up, the ankle was painless, but due to restricted weight-bearing, the mineral density ofthe ankle had decreased as seen on radiographs (b). On the last follow-up (15 months after the procedure), the ankle was symptomless and radiographs were interpreted as normal (c).
case_images: JOCR-8-23-g001.jpg
case_images: PMC5974671_01_JOCR-8-23-g001.jpg
case_images: F1
case_images: The radiographs were normal (Fig. 1a), but the MRI revealed ARC O Stage I osteonecrosis of the talus with increased signal on T2- weighted fat-saturated images and decreased signal on T1- weighted images; an additional minor crescent sign was also present (Fig. 2a and b). Radiographs were normal except for the low mineral density of the bones in general (Fig. 1b).
case_images: Magnetic resonance imaging (MRI) studies of the right ankle. On the initial MRI, the fluid-sensitive sagittal T2-weighted fat-saturated (a) image shows significant bone marrow edema (hyperintense signal) in the talus. The T1-weighted sagittal image (b) shows corresponding bone marrow edema as hypointense signal in the talus. On both sequences, a minor crescent sign can be distinguished on the talar dome (arrows in a, b). The 3-month follow-up, MRI shows complete resolution of the osteonecrotic appearance in the talus on fluid-sensitive proton density fat- saturated (c) and T1-weighted sagittal images (d). Some patchy osteoporosis can be distinguished (arrows in c). On the 15-month follow-up MRI, the talus appears normal on proton density fat- saturated (e) and on T1-weighted images (f).
case_images: JOCR-8-23-g002.jpg
case_images: PMC5974671_01_JOCR-8-23-g002.jpg
case_images: F2
case_images: The MRI revealed virtually complete resolution of the talar osteonecrotic changes (Fig. 2c and d). On the subsequent 15-month follow-up, the patient presented no symptoms and the MRI scan (Fig. 2e and f) as well as the radiographs (Fig. 1c) were normal.
case_images: The procedure using fluoroscopic guidance, core decompression ofthe talar dome was performed using a guidance spike (arrowhead) and a 2.7 mm drill (arrow) (a). In addition to standard procedure, autologic mesenchymal stem cells combined with platelet-rich plasma were injected into the osteonecrotic region in the talus (b).
case_images: JOCR-8-23-g003.jpg
case_images: PMC5974671_01_JOCR-8-23-g003.jpg
case_images: F3
case_images: Next, the PRP-BMA concoction was injected into the osteonecrotic region under fluoroscopic control using a 3 mm aspiration needle (Fig. 3).