Surgical Intervention for Small Osteochondral Lesions (<1 cm): Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle
Alexander Tham, Jared Rubin, James J. Butler, John G. Kennedy, Charles P. Hannon, Steve Bayer, Christopher D. Murawski, Gian Luigi Canata, Thomas O. Clanton, Daniel Haverkamp, Jin Woo Lee, Martin O’Malley, Hua Yinghui, James W. Stone, , Samuel B. Adams, Carol L. Andrews, Chayanin Angthong, Jorge P. Batista, Christoph Becher, Gregory C. Berlet, Lorraine A. T. Boakye, Roberto Buda, Jari Dahmen, Pieter D’Hooghe, Christopher W. DiGiovanni, Malcolm E. Dombrowski, Richard D. Ferkel, Paulo N. F. Ferrao, Mark Glazebrook, Eric Giza, Mohamed Gomaa, Simon Görtz, Amgad M. Haleem, Kamran S. Hamid, Laszlo Hangody, Jay Hertel, Beat Hintermann, MaCalus V. Hogan, Kenneth J. Hunt, Eoghan T. Hurley, John Karlsson, Gino M. M. J. Kerkhoffs, Hak Jun Kim, Siu Wah Kong, Sameh A. Labib, Kaj T. A. Lambers, Keun Bae Lee, Jeffrey S. Ling, Umile Giuseppe Longo, Alberto Marangon, Graham McCollum, Peter N. Mittwede, Stefan Nehrer, Philipp Niemeyer, James A. Nunley, David O. Osei-Hwedieh, Jochen Paul, Adam Popchak, Marcelo P. Prado, Steven M. Raikin, Mikel L. Reilingh, Benjamin B. Rothrauff, Lew C. Schon, Helene Simpson, Niall A. Smyth, Carolyn M. Sofka, Martin Sullivan, Masato Takao, Yasuhito Tanaka, David B. Thordarson, Rocky Tuan, Victor Valderrabano, C. Niek van Dijk, Pim A. D. van Dijk, Francesca Vannini, Tanawat Vaseenon, Markus Walther, Martin Wiewiorski, Xiangyang Xu, Youichi Yasui, Ichiro Yoshimura, Alastair S. E. Younger, Zijun ZhangBackground
Evidence guiding best practices in ankle cartilage repair remains limited and of poor quality. To address this, an international expert group convened to establish consensus opinions on key topics, focusing here on the treatment of small osteochondral lesions, defined as less than 1 cm.
Methods
Experts from 25 countries participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%).
Results
Fourteen of 15 proposed statements achieved consensus, including 13 with ≥86% agreement. Bone marrow stimulation (BMS) was recommended for full-thickness osteochondral lesions of the talus (OLTs) that failed conservative therapy, ideally <10 mm in diameter and <100 mm 2 in area, with poorer outcomes expected in larger lesions. Experts emphasized thorough debridement to stable margins, careful subchondral perforation, and the potential value of biologic augmentation such as platelet-rich plasma or concentrated bone marrow aspirate. Repeat BMS was considered a limited option with inferior outcomes compared with primary procedures or salvage techniques.
Conclusions
This international consensus provides standardized guidance for the indications, technique, and biologic augmentation of BMS in the management of OLT. The recommendations redefine lesion size thresholds and clarify the restricted role of revision BMS, offering a global reference framework for clinical practice and future research.