For osteochondral injuries of the talus, if conservative treatment does not work for 3-6 months, or if the injury is severe and large, surgical treatment needs to be considered. Minimally invasive surgery is currently the most commonly used treatment, primarily through ankle arthroscopy to clear the lesion and perform lesion clearance or microfracture surgery. Arthroscopically, the denuded cartilage (arrows) can be seen and the probing hooks indicate subchondral bone damage. First, the detached, unstable or necrotic cartilage is cleaned out under the arthroscope. This is because the damaged cartilage is not only unsupportive and unprotective, but also “disruptive”. Once the lesion is cleared, microfracture surgery, a type of bone marrow stimulation, is performed. It involves drilling small holes in the bone beneath the cartilage, through which a portion of the bone marrow and blood leaks out to form a blood clot. This blood clot contains stem cells that can differentiate into cartilage-forming cells, providing the patient with a new cartilage substitute. Arthroscopic microfracture surgery, which sees blood oozing out of the bone foramen, results in significant relief of pain symptoms and significant improvement in motion in 80-90% of patients with osteochondral injuries of the talus after microfracture surgery hands. In addition, microfracture surgery is a minimally invasive procedure with minimal trauma. The entire surgery takes about 30-60 minutes and the postoperative hospital stay is only 1 day. So, are all patients with osteochondral injuries of the talus suitable for microfracture treatment? The answer is no. The following two types of patients are not suitable: 1. Microfracture is only suitable for osteochondral injuries of the talus with lesions <1.5 cm in diameter, and other treatments need to be considered when the lesions are too large; 2. Microfracture surgery is suitable for patients with particularly intact subchondral bone, and these patients need to have holes drilled in the bone to allow the stem cells in the bone marrow to seep out. If the subchondral bone has also fallen off in part, the stem cells in the bone marrow open up automatically, and in this case, microfracture surgery is not necessary, and only lesion cleaning is required. In addition, it is worth noting that the original cartilage in the human body is hyaline cartilage, which is currently considered to be non-renewable and difficult to repair on its own once it is damaged. What is formed after microfracture surgery is fibrocartilage, a joint cartilage replacement. It is not as flexible or as high quality as hyaline cartilage, but it is sufficient to maintain daily activity, except that it is not suitable for strenuous exercise. The length of time this articular cartilage replacement can be used is generally related to each patient's use and exercise. Some patients are able to use it for the rest of their lives, but about 10% of patients experience pain and other symptoms again some time after surgery, or even need another surgery. The reason for the reappearance of pain is often because the patient has played some strenuous sports, such as playing soccer or basketball. Therefore, if you are not a professional athlete, it is generally not recommended to play strenuous sports again after surgery. As for activities such as climbing, you need to wait until you have recovered well after surgery and walk without pain in general before considering doing so.