Summary
This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.
Abstract
Introduction
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 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 one 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. The two statements that achieved unanimous support were regarding that aspects of the patient history can be documented in the setting of a known or suspected cartilage lesion of the ankle, and that lesion size can be estimated in 3 planes, including surface area and depth of the lesion. If precise measurement is required including depth, the use of CT is recommended. For daily practice, a size estimate using MRI is appropriate.
Discussion And Conclusion
This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.