Osteochondritis dissecans of the talus is a potential cause of chronic post-traumatic ankle pain. Soft-tissue ultrasound (US) traditionally is rarely used to detect intra-articular lesions. With two case reports, we suggest that a unique soft-tissue US picture, large amount of ankle joint effusion without ligament injury and no obvious bone fracture on radiography, should hint the intra-articular pathology. Two patients with chronic ankle pain following sprain received US assessment of the ankle for the initial radiographs, disclosed no bone fracture. The images revealed a large amount of effusion in the ankle joint with no evidence of fracture or extra-articular ligament injury, suggesting intra-articular lesions. Subsequent magnetic resonance imaging studies confirmed the underlying osteochondritis dissecans of talus.
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