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 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 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.

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.

Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 41S-47S ◽  
Author(s):  
Benjamin B. Rothrauff ◽  
Christopher D. Murawski ◽  
Chayanin Angthong ◽  
Christoph Becher ◽  
Stefan Nehrer ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Best Practice ◽  
Consensus Meeting ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
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 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 “Scaffold-Based Therapies” 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 9 statements on scaffold-based therapies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 8 reached strong consensus (greater than 75% agreement), and 1 was removed because of redundancy in the information provided. All statements reached at least 80% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with applying scaffold-based therapies as a treatment strategy for osteochondral lesions of the talus. Level of Evidence: Level V, expert opinion.

Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 3S-8S ◽  
Author(s):  
Christiaan J. A. van Bergen ◽  
Onno L. Baur ◽  
Christopher D. Murawski ◽  
Pietro Spennacchio ◽  
Dominic S. Carreira ◽  
...  
Keyword(s):  
Physical Examination ◽  
Cartilage Repair ◽  
Best Practice ◽  
Consensus Meeting ◽  
International Consensus ◽  
Best Practice Guidelines ◽  
Consensus Statements ◽  
Cartilage Injuries ◽  
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 “Diagnosis: History, Physical Examination, Imaging, and Arthroscopy” 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 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: A total of 12 statements on the diagnosis of cartilage injuries of the ankle reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support and 10 reached strong consensus (greater than 75% agreement). All statements reached at least 86% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.

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.

Post-treatment Follow-up, Imaging, and Outcome Scores: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

2018 ◽  
Vol 39 (1_suppl) ◽  
pp. 68S-73S ◽  
Author(s):  
Pim A. D. van Dijk ◽  
Christopher D. Murawski ◽  
Kenneth J. Hunt ◽  
Carol L. Andrews ◽  
Umile Giuseppe Longo ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Best Practice ◽  
Consensus Meeting ◽  
Post Treatment ◽  
International Consensus ◽  
Consensus Statements ◽  
Outcome Scores ◽  
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 Post-treatment Follow-up, Imaging and Outcome Scores 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 on 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 Post-treatment Follow-up, Imaging, and Outcome Scores reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 12 statements reached strong consensus (greater than 75% agreement). Conclusions: This international consensus derived from leaders in the field will assist clinicians with post-treatment follow-up, imaging, and outcome scores after management of a cartilage injury of the ankle in the general population. Moreover, healing, rehabilitation, and final outcomes can be optimized for the individual patient.

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