Mr Mark Farndon recently spoke at the Ankle Arthritis Academy 2026, held at the Hilton Newcastle Gateshead on 9 and 10 June.
The two-day meeting brought together experienced UK and international foot and ankle surgeons to discuss the assessment and treatment of ankle arthritis. The programme covered early arthritis, osteochondral injuries, complex ankle fusion, total ankle replacement and revision surgery.
Mark’s presentation, “My strategy for the large (20mm) OCD”, formed part of the opening session on decision-making and early ankle osteoarthritis.
What is an osteochondral defect of the ankle?
An osteochondral defect, sometimes called an osteochondral lesion or OCD, is an area of damage involving the cartilage and underlying bone within the ankle joint.
These injuries most commonly affect the talus, one of the main bones forming the ankle. They may develop following an ankle sprain or other injury, although some patients cannot recall a single event that caused the problem.
Symptoms can include:
- Persistent pain deep within the ankle
- Swelling after walking or exercise
- Stiffness or reduced movement
- Clicking, catching or locking
- Difficulty returning to sport or normal activity
Small lesions may sometimes be managed without surgery. Larger osteochondral defects can be more difficult to treat, particularly when both the cartilage and the bone beneath it have been significantly damaged.
Why does the size of the lesion matter?
The size, depth and location of an osteochondral lesion can influence the treatment options available.
A large lesion measuring around 20mm presents different challenges from a small, contained area of cartilage damage. Treatment decisions may also depend on the condition of the surrounding cartilage, the quality of the underlying bone, previous surgery and whether ankle arthritis is already developing.
In his presentation, Mark discussed his approach to assessing these larger lesions and selecting an appropriate treatment strategy.
The aim is not simply to treat an MRI or scan finding. The patient’s symptoms, activity levels, previous injuries and expectations all need to be considered before deciding whether surgery is appropriate.
Treatment options for a large ankle cartilage injury
There is no single operation that is suitable for every osteochondral defect.
Depending on the findings, treatment may involve:
- Removing unstable or damaged tissue from the joint
- Stimulating the underlying bone to encourage a healing response
- Bone grafting where there is a deeper defect or cyst
- Cartilage restoration or transplantation techniques
- Correcting ankle alignment or instability contributing to the problem
- Treating established ankle arthritis where joint preservation is no longer realistic
Some patients may also benefit from physiotherapy, activity modification, pain relief, bracing or injection treatments before surgery is considered.
The most suitable approach depends on the individual ankle rather than the lesion size alone.
Ankle arthritis and joint-preserving treatment
Osteochondral damage can contribute to ankle pain and, in some cases, the later development of arthritis.
When possible, treatment in a younger or active patient may focus on preserving the ankle joint. This can involve addressing cartilage damage alongside other problems such as instability, poor alignment or previous fracture deformity.
However, joint-preserving surgery is not suitable in every case. Where arthritis is more advanced, other options such as ankle fusion or total ankle replacement may need to be discussed.
A careful assessment helps establish whether the main source of pain is a localised cartilage lesion, more widespread arthritis or a combination of problems.
Sharing experience at the Ankle Arthritis Academy
The Ankle Arthritis Academy was designed around practical decision-making, case discussion and the challenges surgeons encounter in everyday practice.
Alongside Mark’s presentation, the opening session considered ankle arthritis networks, joint distraction and patient selection for total ankle replacement. The wider programme covered complex fusion surgery, large bone defects, primary ankle replacement and revision procedures.
Meetings of this kind allow surgeons to compare different approaches, discuss difficult cases and review how treatment can be improved for patients with ankle cartilage damage and arthritis.
Assessment of persistent ankle pain
Persistent ankle pain following an injury should not always be dismissed as a slow recovery from a sprain.
Further assessment may be appropriate when pain, swelling or catching continues despite rest and rehabilitation. This will usually include a clinical examination and weight-bearing X-rays. An MRI or CT scan may also be recommended when an osteochondral lesion is suspected.
Mr Mark Farndon assesses patients with ankle pain, cartilage injuries and ankle arthritis. Following an examination and review of the relevant scans, he can explain the available non-surgical and surgical treatment options.
