Post-Treatment Follow-up, Rehabilitation, and Return to Sport: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Background Postoperative follow-up, rehabilitation, and return to sport (RTS) are key components of recovery following surgical management of osteochondral lesions of the talus (OLT). However, substantial variability exists in postoperative protocols, with limited high-quality evidence guiding clinical practices Methods International experts convened during the International Congress on Cartilage Repair of the Ankle (ICCRA) in Pittsburgh, USA (2017), with subsequent ratification of recommendations in New York, USA (2025). The original consensus statements were developed using a modified Delphi process involving electronic surveys, structured questionnaires, and expert discussion. Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%). The recommendations addressed postoperative follow-up, rehabilitation, and RTS following OLT management. Results A total of 16 consensus statements were developed and subsequently ratified, comprising 7 statements addressing post-treatment follow-up and 9 addressing rehabilitation and RTS. All statements achieved strong consensus, with agreement ranging from 75% to 98%. Follow-up recommendations emphasized standardized clinical assessment and patient-reported outcomes, with extended monitoring in select patients. Rehabilitation recommendations supported early controlled motion and progressive weightbearing, with individualized progression according to procedure and clinical performance. Return to sport recommendations emphasized functional recovery and individualized decision-making. Ten statements (63%) were classified exclusively as Grade E, highlighting the limited evidence supporting several recommendations. Conclusion The ICCRA consensus statements establish a structured framework for postoperative follow-up, rehabilitation, and RTS following surgical management of OLT. Despite strong expert agreement, several recommendations remain supported by limited evidence, underlining the need for prospective studies to establish validated, procedure-specific rehabilitation protocols and objective RTS criteria. Level of Evidence: V, expert consensus

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Journal
Foot & Ankle Specialist
Published
2026-11-06
DOI
https://doi.org/10.1177/19386400261504161
Primary Topic
Foot and Ankle Surgery
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article
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article

Post-Treatment Follow-up, Rehabilitation, and Return to Sport: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Lew Charles Schon, Rocky S. Tuan, Martin O’Malley, Stefan Nehrer et al.
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Foot & Ankle Specialist
Foot and Ankle Surgery
article

Post-Treatment Follow-up, Rehabilitation, and Return to Sport: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Lew Charles Schon, Rocky S. Tuan, Martin O’Malley, Stefan Nehrer, Mark Anthony Glazebrook, Peter N. Mittwede, Masato Takao, Beat Hintermann, Kenneth John Hunt, Jari Dahmen, James A. Nunley, Thomas Oscar Clanton, Markus Walther, Christian J. A. van Bergen, David O. Osei-Hwedieh, Gregory C. Berlet, Simon Görtz, Kamran S. Hamid, Yinghui Hua, Chayanin Angthong, Samuel Bruce Adams, Sameh A. Labib, Lorraine A. T. Boakye, Steven M. Raikin, Niall A. Smyth, Christopher D. Murawski, MaCalus Vinson Hogan, Laszlo Rudolf Hangody, Charles Patrick Hannon, Daniël Haverkamp, Alastair S. E. Younger, Pieter P. R. N. d’Hooghe, Benjamin B. Rothrauff, Youichi Yasui, Carol L. Andrews, Jay N. Hertel, Graham McCollum, C. Niek van Dijk, Richard D. Ferkel, Martin Sullivan, Pim A. D. van Dijk, Eoghan T. Hurley, Paulo N. F. Ferrao, Dominic S. Carreira, Alberto Marangon, Víctor Valderrábano, Adam Popchak, Tanawat Vaseenon, Jorge Pablo Batista, Gian Luigi Canata, Martin J. Wiewiorski, Alexander Tham, Kaj T. A. Lambers, Gino M. M. J. Kerkhoffs, Alexandra J. Brown, Francesca Vannini, Hélder Pereira, Roberto Buda, Umile Giuseppe Longo, Eric Giza, David B. Thordarson, Helene Simpson, Malcolm E. Dombrowski, Kong Siu-Wah, Ichiro Yoshimura, Jeffrey S. Ling, Pietro Spennacchio, Marcelo P. Prado, Christopher William DiGiovanni, Christoph Becher, Philipp Niemeyer, John G. Kennedy, Adam W. Mitchell, Amgad M. Haleem, Jochen Paul, James D. F. Calder, Keun Bae Lee, Mikel L. Reilingh, Christopher Jon Pearce, JON LÖVE KARLSSON, Carolyn M. Sofka, James W. Stone, Davis T. Hedbany, Paloma Gauthier, James J. Butler, Jared Rubin, Stephen Bayer, Mohamed Gomaa, Xiangyang Xu, Jin Woo Lee, Yasuhito Tanaka, Hak Jun Kim, Zijun Zhang
article en

Abstract

Background Postoperative follow-up, rehabilitation, and return to sport (RTS) are key components of recovery following surgical management of osteochondral lesions of the talus (OLT). However, substantial variability exists in postoperative protocols, with limited high-quality evidence guiding clinical practices Methods International experts convened during the International Congress on Cartilage Repair of the Ankle (ICCRA) in Pittsburgh, USA (2017), with subsequent ratification of recommendations in New York, USA (2025). The original consensus statements were developed using a modified Delphi process involving electronic surveys, structured questionnaires, and expert discussion. Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%). The recommendations addressed postoperative follow-up, rehabilitation, and RTS following OLT management. Results A total of 16 consensus statements were developed and subsequently ratified, comprising 7 statements addressing post-treatment follow-up and 9 addressing rehabilitation and RTS. All statements achieved strong consensus, with agreement ranging from 75% to 98%. Follow-up recommendations emphasized standardized clinical assessment and patient-reported outcomes, with extended monitoring in select patients. Rehabilitation recommendations supported early controlled motion and progressive weightbearing, with individualized progression according to procedure and clinical performance. Return to sport recommendations emphasized functional recovery and individualized decision-making. Ten statements (63%) were classified exclusively as Grade E, highlighting the limited evidence supporting several recommendations. Conclusion The ICCRA consensus statements establish a structured framework for postoperative follow-up, rehabilitation, and RTS following surgical management of OLT. Despite strong expert agreement, several recommendations remain supported by limited evidence, underlining the need for prospective studies to establish validated, procedure-specific rehabilitation protocols and objective RTS criteria. Level of Evidence: V, expert consensus

Foot & Ankle Specialist
Semmelweis University (HU), Chonnam National University (KR), Hospital for Special Surgery (US), Cedars-Sinai Medical Center (US), Brigham and Women's Hospital (US), Rush University Medical Center (US), Dalhousie University (CA), Loyola University Medical Center (US), Universität für Weiterbildung Krems (AT), Mercy Medical Center (US), Harvard University (US), University of British Columbia (CA), Cairo University (EG), Emory University (US), University of Cape Town (ZA), Centre Hospitalier de Luxembourg (LU), University of Pittsburgh (US), Duke University (US), Shanghai Jiao Tong University (CN), Yonsei University (KR), Fudan University (CN), University of Michigan (US), Thomas Jefferson University Hospital (US), Hospital of the University of Pennsylvania (US), Queen Elizabeth II Health Sciences Centre (CA), Hospital Israelita Albert Einstein (BR), Sahlgrenska University Hospital (SE), University Medical Center Freiburg (DE), Ruijin Hospital (CN), Slotervaartziekenhuis (NL), University of Colorado System (US), UNSW Sydney (AU), Fukuoka University (JP), Magna Graecia University (IT), University of Chieti-Pescara (IT), NYU Langone Health (US), Massachusetts General Hospital (US), Kantonsspital Baselland (CH), Chonnam National University Hospital (KR), Schön Klinik München Harlaching (DE), Kantonsspital Winterthur (CH), Cleveland Clinic Florida (US), Prince of Wales Hospital (AU), Steadman Clinic (US), Orthopedic Foot & Ankle Center (US), Ospedale Koelliker (IT), Istituto Ortopedico Rizzoli (IT), St Vincent's Clinic (AU), Uzsoki Hospital (HU), München Klinik Harlaching (DE), Azienda Ospedaliero-Universitaria "Renato Dulbecco" (IT), University of Pittsburgh Medical Center (US), Campus Bio Medico University Hospital (IT), Rothman Institute (US), Ospedale SS. Annunziata (IT), Amsterdam University Medical Centers (NL), Southern California Orthopedic Institute (US), Peachtree Orthopaedic Clinic (US), Fortius Clinic (GB), Loyola Medicine (US), Huashan Hospital (CN), Cairo University hospitals (EG), Praxisklinik Rennbahn AG (CH), Korea University Guro Hospital (KR), Imperial College London (GB), Chiang Mai University (TH), University of Virginia (US), University of Colorado Anschutz Medical Campus (US), Nara Medical University (JP), Albany Medical Center Hospital (US), University of Pennsylvania (US), Ludwig-Maximilians-Universität München (DE), University of California, Davis (US), Teikyo University (JP), University of Amsterdam (NL), University of Bologna (IT)
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