The surgical approach depends on the size and severity of the defect:

• Microfracture (for small defects, <10 mm)

  • Tiny holes are drilled into the bone to stimulate new cartilage growth.

  • Performed via minimally invasive ankle arthroscopy.

• Osteochondral Autograft Transfer (OATS) (for medium-sized defects, 10–20 mm)

  • A plug of healthy cartilage and bone is taken from a non-weight-bearing area and transplanted into the defect.

• Autologous Chondrocyte Implantation (ACI) (for larger defects, >20 mm)

  • Patient’s cartilage cells are harvested, grown in a lab, and later implanted into the defect.

  • Requires two surgeries: one to collect the cells and another to implant them.

Some cases may require bone grafting if there is significant bone loss, or osteotomy (realignment of the bone) if the ankle joint is abnormally positioned.

Surgery is performed under general or regional anesthesia

Non-operative management may be attempted before surgery and includes:

• Activity Modification – Avoiding high-impact activities.

• Physiotherapy – Strengthening and mobility exercises.

• Bracing or Orthotics – Support to offload the affected area.

• Pain Management – NSAIDs or corticosteroid injections for temporary relief.

• Biologic Injections (PRP or Stem Cells) – Experimental treatments with mixed evidence for cartilage healing.

Surgery is considered when these treatments fail to relieve symptoms or when the defect is large and unlikely to heal on its own.

Although OCD surgery has good success rates (~80–90%), potential risks include:

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General Surgical Risks:

• Infection – Uncommon (<1%), but may require antibiotics or further surgery if it occurs.

• Blood Clots (DVT/PE) – Low risk but possible; movement and blood thinners may be used in high-risk cases.

• Nerve Injury – Rare, but there is a small risk of numbness or tingling due to nerve irritation.

• Wound Healing Issues – More common in smokers or diabetics.

 

Procedure-Specific Risks:

• Failure of Cartilage Healing – New cartilage may not form correctly, leading to persistent pain.

• Recurrent Symptoms – Some patients may have residual pain, stiffness, or swelling even after successful surgery.

• Joint Stiffness – Scar tissue formation can restrict ankle movement.

• Progressive Arthritis – If the cartilage damage is severe, arthritis may still develop over time.

• Graft Failure (in OATS or ACI) – The transplanted cartilage may not integrate properly.

 

Long-term research suggests that early treatment of OCDs leads to better outcomes and may slow or prevent the progression of arthritis.

Time Off Work

• Desk jobs: 2–4 weeks

• Manual labor: 8–12 weeks

 

Return to Driving

• 6–8 weeks, depending on the foot operated and weight-bearing status.

 

Return to Activities & Sports

• Low-impact activities: 3 months

• Running: 4–6 months

• High-impact sports: 6–12 months

 

Rehabilitation Timeline

• Weeks 0–6: Non-weight-bearing in a boot; gentle range-of-motion exercises.

• Weeks 6–12: Gradual weight-bearing, physiotherapy for strength and mobility.

• 3–6 months: Progressive strengthening, balance training, and low-impact activities.

• 6–12 months: Return to sports based on recovery and physiotherapy clearance.

 

Most patients achieve significant pain relief and improved function, though full recovery depends on the size of the defect and surgical technique used.