HISTORY 18-year old male basketball player presents with left ankle pain after playing basketball the previous night. Patient states he jumped up and twisted his ankle when he landed onto another player's foot. He was uncertain of how his ankle twisted. After falling, he was unable to bear weight. Overnight, the ankle swelled more than it had with previous ankle sprains. He iced one time and took ibuprofen. Of note, he twisted the same ankle about one week prior to this injury but continued to play despite this initial injury. PHYSICAL EXAM The patient entered the examining room via a wheelchair. He was not able to bear any weight and hopped up to the examining table. His left ankle was swollen diffusely both medially and laterally but no visible ecchymosis. Active range of motion was minimal in all directions. Passive range of motion was slightly better but still very limited due to exquisite pain. Patient had no point tenderness over the lateral malleolus but was diffusely tender in the surrounding soft tissue. Patient had anterior joint line tenderness, greater on the lateral aspect. He was not tender over the medial malleolus, 5th metatarsal, proximal tibia or fibula, or Achilles tendon. Sensation was normal throughout his left lower extremity. Capillary refill was normal. DIFFERENTIAL DIAGNOSIS Severe ankle sprain. Medial or lateral malleolus fracture. Talar dome fracture. Osteochondral defect. TESTS AND RESULTS 7/25/02: Ankle radiographs: minimally displaced type 3 osteochondral fracture of the anterolateral talus. FINAL/WORKING DIAGNOSIS Type 3 anterolateral osteochondral fracture of the talus. TREATMENT AND OUTCOMES Non-weight bearing in short leg cast. Surgical repairfixation of osteochondral fracture via arthrotomy. Non-weight bearing for 6 weeks. Active/passive ROM. Progressive resistive exercise then functional strengthening. Return to competition when pain free and strength equal.