scholarly journals Terminology for Osteochondral Lesions of the Ankle Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2022 ◽  
Author(s):  
Christopher D. Murawski ◽  
M. Shazil Jamal ◽  
Eoghan T. Hurley ◽  
Roberto Buda ◽  
Kenneth Hunt ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
International Consensus

Conservative Management and Biological Treatment Strategies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 9S-15S ◽  
Author(s):  
Malcolm E. Dombrowski ◽  
Youichi Yasui ◽  
Christopher D. Murawski ◽  
Lisa A. Fortier ◽  
Eric Giza ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Conservative Management ◽  
Biological Treatment ◽  
Treatment Strategies ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
International Consensus ◽  
Consensus Statements ◽  
Working Groups ◽  
Strong Consensus

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Conservative Management and Biological Treatment Strategies” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 12 statements on Conservative Management and Biological Treatment Strategies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Ten statements reached strong consensus (greater than 75% agreement), and 2 achieved consensus. Conclusions: This international consensus derived from leaders in the field will assist clinicians with conservative management and biological treatment strategies for osteochondral lesions of the talus.

scholarly journals Debridement, Curettage, Microfracture, and Fixation Techniques for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Keyword(s):  
Cartilage Repair ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
Evidence Based ◽  
International Consensus ◽  
Consensus Group ◽  
Consensus Statements ◽  
Fixation Techniques ◽  
Strong Consensus ◽  
Evidence Based Guidelines

Category: Ankle Introduction/Purpose: Osteochondral lesions of the talus (OLTs) are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Debridement, curettage, microfracture, and fixation techniques are surgical modalities to treat the lesion and were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on debridement, curettage, microfracture, and fixation techniques for osteochondral lesions of the talus. Methods: 75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including debridement, curettage, microfracture, and fixation techniques. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: 29 statements addressing debridement, curettage, microfracture, and fixation techniques reached some degree of consensus. In the case of microfracture, 94% (strong consensus) agreed that the ideal size guidelines are lesions <10 mm in diameter, <100 mm2 in area, and <5 mm in depth. In addition, 92% (strong consensus) voted that lesion size, location, presence of cyst(s), containment of lesion, joint alignment, bone marrow edema, ankle stability, and previous cartilage repair procedures are all important local prognostic factors for microfracture. For fixation, 90% of participants (strong consensus) voted that a stable displaced OLT fragment or a nondisplaced OLT fragment should be fixed as soon as possible in order to maximize healing potential and minimize intra-articular damage. Conclusion: There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing osteochondral lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the treatment of a cartilage lesion of the talus using debridement, curettage, microfracture, and fixation techniques.

scholarly journals Osteochondral Autograft and Allograft for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0026
Author(s):  
Keyword(s):  
Cartilage Repair ◽  
Donor Site ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
Evidence Based ◽  
International Consensus ◽  
Osteochondral Autograft ◽  
Cartilage Lesions ◽  
Allograft Transplantation ◽  
Evidence Based Guidelines

Category: Ankle Introduction/Purpose: Cartilage lesions of the talus are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Osteochondral autograft and allograft transplantation are surgical modalities to replace the lesion and were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on the use of osteochondral autograft and allograft for osteochondral lesions of the talus. Methods: 75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including osteochondral autograft and allograft. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the working groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: 29 statements addressing osteochondral autograft and allograft transplantation for cartilage lesions of the talus reached some degree of consensus. These included conclusions on what lesion types/sizes are amenable to this treatment, optimal donor site sources, use of biological augmentation, prognostic factors, and expected outcomes. There was a consensus that: [1] Osteochondral autograft should be considered in primary cystic lesions greater than 1 cm in diameter. [2] The lateral femoral condyle is the preferred osteochondral autograft donor site. [3] It is unnecessary to backfill an osteochondral autograft donor site. [4] Bulk osteochondral allograft transplant should be used in uncontained lesions that cannot be addressed with an osteochondral autograft. No statement achieved less than an 83% consensus following anonymous voting by the expert group. Conclusion: There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing cartilage lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the treatment of a cartilage lesion of the talus using osteochondral autograft or allograft transplantation.

Osteochondral Lesions of the Tibial Plafond and Ankle Instability With Ankle Cartilage Lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2022 ◽  
pp. 107110072110491
Author(s):  
Jari Dahmen ◽  
Steve Bayer ◽  
James Toale ◽  
Conor Mulvin ◽  
Eoghan T. Hurley ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Ankle Instability ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
International Consensus ◽  
Cartilage Lesions ◽  
Tibial Plafond ◽  
Consensus Statements ◽  
Working Groups ◽  
Strong Consensus

Background: An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held. Results: A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement). Conclusions: These consensus statements may assist clinicians in the management of these difficult clinical pathologies. Level of Evidence: Level V, mechanism-based reasoning.

Osteochondral Allograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 35S-40S ◽  
Author(s):  
Niall A. Smyth ◽  
Christopher D. Murawski ◽  
Samuel B. Adams ◽  
Gregory C. Berlet ◽  
Roberto Buda ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Best Practice ◽  
Consensus Meeting ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
International Consensus ◽  
Best Practice Guidelines ◽  
Consensus Statements ◽  
Working Groups ◽  
Strong Consensus

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Osteochondral Allograft” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: A total of 15 statements on osteochondral allograft reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support and 14 reached strong consensus (greater than 75% agreement). All statements reached at least 85% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with osteochondral allograft as a treatment strategy for osteochondral lesions of the talus.

Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 23S-27S ◽  
Author(s):  
Mikel L. Reilingh ◽  
Christopher D. Murawski ◽  
Christopher W. DiGiovanni ◽  
Jari Dahmen ◽  
Paulo N. F. Ferrao ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Best Practice ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
International Consensus ◽  
Best Practice Guidelines ◽  
Consensus Statements ◽  
Fixation Techniques ◽  
Working Groups ◽  
Strong Consensus

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Fixation Techniques” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: A total of 15 statements on fixation techniques reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 15 statements achieved strong consensus, with at least 82% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with using fixation techniques in the treatment of osteochondral lesions of the talus.

Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 16S-22S ◽  
Author(s):  
Charles P. Hannon ◽  
Steve Bayer ◽  
Christopher D. Murawski ◽  
Gian Luigi Canata ◽  
Thomas O. Clanton ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cartilage Repair ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
International Consensus ◽  
Marrow Stimulation ◽  
Consensus Statements ◽  
Working Groups ◽  
Strong Consensus

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Debridement, Curettage and Bone Marrow Stimulation” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 14 statements on debridement, curettage, and bone marrow stimulation reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 12 reached strong consensus (greater than 75% agreement), and 1 achieved consensus. All statements reached at least 72% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with debridement, curettage and bone marrow stimulation as a treatment strategy for osteochondral lesions of the talus.

scholarly journals Conservative Management and Biological Treatment Strategies for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0026
Author(s):  
Keyword(s):  
Cartilage Repair ◽  
Conservative Management ◽  
Biological Treatment ◽  
Treatment Strategies ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
Evidence Based ◽  
International Consensus ◽  
Strong Consensus ◽  
Evidence Based Guidelines

Category: Ankle Introduction/Purpose: Cartilage lesions of the talus are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Conservative management and biological treatment strategies are controversial and were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on conservative management and the use of biological treatment strategies for osteochondral lesions of the talus. Methods: 75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including conservative management and biological treatment strategies. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the working groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: 15 statements addressing conservative management and biological treatment strategies for osteochondral lesions of the talus reached some degree of consensus. In the case of conservative management, 81% (strong consensus) voted in favor of the optimal protocol for an acute non-displaced lesion being immobilization for 4-6 weeks with touchdown weightbearing, with non-steroidal anti-inflammatory drugs only prescribed in cases of significant pain and swelling. With respect to biological strategies, 90% of participants concluded that human cell/tissue products and orthobiologics may improve the quality of repair tissue and improve patient outcomes. However, there is currently no optimal formulation, cell source, or cell concentration of the available biological products in the setting of cartilage repair. Conclusion: There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing osteochondral lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the treatment of a cartilage lesion of the talus using conservative management or biological treatment strategies.

Osteochondral Autograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 28S-34S ◽  
Author(s):  
Eoghan T. Hurley ◽  
Christopher D. Murawski ◽  
Jochen Paul ◽  
Alberto Marangon ◽  
Marcelo P. Prado ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Treatment Guidelines ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
International Consensus ◽  
Osteochondral Autograft ◽  
Cartilage Lesions ◽  
Consensus Statements ◽  
Working Groups ◽  
Strong Consensus

Background: Treatment guidelines for cartilage lesions of the talus have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. The purpose of this consensus article is to explain the process and delineate the consensus statements derived from this consensus meeting on the use of “osteochondral autograft” for osteochondral lesions of the talus. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: A total of 14 statements on osteochondral autograft reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support, 11 reached strong consensus (greater than 75% agreement), and 1 achieved consensus. All statements reached at least 67% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with osteochondral autograft as a treatment strategy for osteochondral lesions of the talus.

scholarly journals Diagnosis, Physical Exam, and Imaging for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0026
Author(s):  
Keyword(s):  
Cartilage Repair ◽  
Cartilage Lesion ◽  
Consensus Meeting ◽  
Physical Exam ◽  
Osteochondral Lesions ◽  
Evidence Based ◽  
International Consensus ◽  
Cartilage Lesions ◽  
Consensus Group ◽  
Evidence Based Guidelines

Category: Ankle Introduction/Purpose: Cartilage lesions of the talus are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Diagnosis, physical exam and imaging were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on the diagnosis, physical exam and imaging for osteochondral lesions of the talus. Methods: 75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including diagnosis, physical exam and imaging. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the working groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: 12 statements addressing diagnosis, physical exam and imaging for cartilage lesions of the talus reached some degree of consensus. These included conclusions on how suspected lesions should be evaluated. There was a consensus that: [1] Weight-bearing AP, lateral, and mortise radiographs should be utilized to evaluate a known or suspected cartilage lesion of the ankle. [2] Lesion size should be estimated in three planes including surface area and depth of the lesion. [3] If precise measurement is required including depth, the use of CT is recommended, but for daily practice, a size estimate using MRI is appropriate. [4] Diagnostic arthroscopy is of limited value and seldom influences treatment approach in the assessment of a known or suspected cartilage lesion of the ankle. Conclusion: There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing cartilage lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the evaluation of a cartilage lesion of the talus including diagnosis, physical exam and imaging.

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