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