Any thoughts on weightbearing arthroscopy of an ankle for osteochondral defects

Hi,

I'm a physiotherapist, although I have limited outpatient and orthopaedic experience, and have a query.

My question is what would seem appropriate weight bearing post surgery?

My surgery was an arthroscopy of my ankle to debride some lose cartilage and to re-surface 2 areas on the talus that had osteochondral defects on. My report from the MRI scan read as follows:

There is a massive joint effusion present and the small avulsion fracture of the distal tibia anteriorly is also confirmed with oedema seen in the adjacent bones. There is also osteochondral damage of the lateral talar dome involving a cross sectional area of approximately 6 x 12mm in size. The ossicle posteriorly is again identified and appears to have normal marrow signal within it. I suspect it is displaced rather than truely fractured. This would be in keeping with the CT findings. There is also evidence of minor osteochondral damage of the posterior sub-talar joint which was not evident on the CT. There is complete rupture of the ATFL and the small bone fragment appears to have retracted further towards the distal fibula, the calcaneal fibular ligament appears thickened and of abnormal signal and is likely to be partially torn. The anterior tibiofibular and posterior tibiofibular and posterior talofibular ligaments appear to remain in tact. There is a small amount of fluid seen around the medial and lateral tendons which is likely to be incidental.

CONCLUSION Severe ankle injury with avulsion fracture of the distal fragment of the ATFL confirmed but also osteochondral damage within the ankle joint and a small distal tibial fracture anteriorly also confirmed. The os trigonum is displaced within the joint fluid posteriorly.

The surgeon advised me to stay partially weight bearing for 4 weeks. I'm on Day 2 today.

There is little swelling, and no pain at all. Prior to the surgery I was able to walk without pain or a limp and the main problem for the joint was at the end end ranges and if I tried to go quicker than walk. The inital injury was just under 3 months ago, which was an inversion injury with someone sat on it.

I dont' really understand why 4 weeks of non partial weightbearing. Taking into consideration healing of the OCD sites, re-bleeding, and fibrocartilage being formed, won't this happen under full weight bearing? The joint isn't being stressed, or fully mobilised to the areas of the OCD sites, as I could feel when they were before.

I know there is alot there, so thanks for reading if you got that far.

Steve