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A 34-year-old active duty military officer has lateral right ankle pain with running during physical training that is worsening over the past 6 months. He recalls sustaining an ankle sprain 3 years ago that resolved with physical therapy. On examination the skin is intact and the talar drawer test is normal. He has pain anterolaterally with end-arc passive dorsiflexion and no pain posteriorly with passive plantarflexion. He has no tenderness on palpation at the distal fibula, anterior talofibular ligament, calcaneofibular ligament. An axial MR arthrogram of the ankle is shown in Figure A. What is the next most appropriate step in management following recalcitrant pain despite conservative management?
Ankle arthropscopy with synovial debridement
Open Brostrom ligament repair with Gould modification
Chrisman-Snook tendon transfer
Syndesmosis reduction and screw fixation
Ankle arthroscopy with loose body removal
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The current body of available evidence supports the use of ankle arthroscopy for all of the following indications EXCEPT:
Debridement of diffuse degenerative ankle cartilage
Anterior ankle impingement
Loose body removal
A 28-year-old rugby player has had anterior ankle pain for several years. On physical exam he has painful and limited dorsiflexion of the ankle. Based on a dorsiflexed ankle radiograph shown in figure A, what is the most appropriate operative treatment?
Arthroscopic chondral drilling
Arthroscopic tibial debridement
Modified Brostrom procedure
Arthroscopic os trigonum excision
Arthroscopic tibiotalar arthrodesis