Osteochondral Debridement/Repair Protocol

Primary Goals:

• Protect the cartilage repair from shear stress during early healing
• Restore ankle range of motion without axial or torsional loading 
• Gradually reintroduce loading and impact in a controlled fashion

Key Restrictions:

• Avoid shear stress across the ankle for the first 6 weeks
• Avoid impact activities for 4–6 months postoperatively 

Weight Bearing:

• Non-weight bearing or touch-down weight bearing in a splint or boot (per surgeon preference)
   

Immobilization:

• Splint or CAM boot at all times except for hygiene and prescribed exercises
   

Range of Motion:

• Begin ankle range of motion out of the boot
   
• Active and active-assisted dorsiflexion and plantarflexion only
   
• Range of motion exercises must be performed non-weight-bearing
   

Restrictions:

• No inversion or eversion
• No loaded dorsiflexion
• No squatting, lunges, or step-downs
• No pivoting or torsional movements

Other:

• Edema control, elevation, cryotherapy as needed
   

Weight Bearing:

• Progress to partial weight bearing, advancing to weight bearing as tolerated in boot only
   

Range of Motion:

• Continue non-weight-bearing dorsiflexion and plantarflexion 
• Gentle inversion and eversion may begin at surgeon discretion, performed non-weight-bearing only
   

Strengthening:

• Isometric exercises in neutral position only
• No resisted ankle strengthening
   

Restrictions:

• No shear-loading activities
• No closed-chain dorsiflexion
• No strengthening in weight-bearing
• No pivoting, twisting, or uneven surfaces
   

Weight Bearing:

• Transition out of boot into supportive shoe or brace as tolerated
   

Range of Motion:

• Full ankle range of motion in all planes
   

Strengthening:

• Begin closed-chain strengthening
• Progressive loading into dorsiflexion
• Proprioceptive and balance training

Restrictions:

• No running, jumping, or impact activities
   

Strengthening:

• Advance lower extremity strengthening 
• Progress proprioception and neuromuscular control

Conditioning:

• Low-impact cardiovascular conditioning (cycling, elliptical, swimming)

Restrictions:

• No impact loading
• No cutting or pivoting activities

Impact Progression:

• Gradual return to impact activities as tolerated and cleared by surgeon
• Begin straight-line jogging, progressing to sport-specific drills 

Goals:

• Restore strength, endurance, and neuromuscular control 
• Prepare for return to full athletic participation
   

• Low-impact activities: after 6–8 weeks 
• Running and impact activities: no earlier than 4 months postoperatively
• Full return to sport: typically 4–6 months postoperatively, depending on lesion size, location, and clinical progress