Background: Ankle distraction arthroplasty (ADA) is a method of treating terminal osteoarthritis of the ankle joint, which allows delaying fusion or total replacement. Aims: The aim of the study was to research the macroscopic image of the articular cartilage before and after ADA using second-look arthroscopy. Methods: A total of 17 ADA surgical interventions were performed. The average age was 48.5±13.57 years, among them 7 females (38.89%) and 10 males (61.11%). 4 patients underwent second-look arthroscopy of the ankle joint after ADA at different times. Results: All patients showed a statistically significant change in the functional outcome by 12 months from the moment of surgery, on the FAAM scale (p-value = 0.00060) and the AO FAS Ankle-hindfoot scale (as well as after removing the Ilizarov frame after 1, 3, 6, and 12 months). The reduction in pain was from 6.17 1.32 cm before surgery to 2 (1.4, 2.1) cm after 12 months. Conclusions: There were signs of regeneration of cartilaginous defects with their covering with cartilage-like soft tissue, which was probably responsible for the analgesic effect of ADA.