Clinical Work-up, Diagnostic Imaging, and Radiographic Classification Systems for Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

BackgroundThe evaluation of osteochondral lesions of the talus (OLT) has long been limited by variability in imaging protocols, lesion measurement techniques, and clinical utility of radiographic classification systems. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the work-up, diagnostic imaging, and radiographic classification systems for OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory 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%).ResultsIn total, 19 consensus statements were achieved across the 3 meetings. Strong agreement was reached for first-line use of weight-bearing radiographs and complementary use of magnetic resonance imaging (MRI) and computed tomography for lesion characterization. Standardized assessment of lesion size in 3 planes and localization using a 9-zone grid were endorsed. Diagnostic arthroscopy was considered to have limited routine value in the setting of advanced imaging. Post-treatment imaging recommendations clarified indications for radiographs and cross-sectional imaging and emphasized the limited correlation between imaging findings and clinical function. Computed tomography-based classification systems were considered more useful for guiding treatment decisions than plain radiographic or MRI-based systems.ConclusionThese international consensus statements establish a standardized imaging-based framework for the evaluation and classification of OLT, improving consistency in diagnosis, treatment planning, and clinical reporting.

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Foot & Ankle Specialist
Published
2026-09-08
DOI
https://doi.org/10.1177/19386400261478702
Primary Topic
Foot and Ankle Surgery
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article
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article

Clinical Work-up, Diagnostic Imaging, and Radiographic Classification Systems for Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Peter N. Mittwede, John G. Kennedy, Thomas Oscar Clanton, Steven Bayer et al.
Foot & Ankle Specialist
Foot and Ankle Surgery
article

Clinical Work-up, Diagnostic Imaging, and Radiographic Classification Systems for Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Peter N. Mittwede, John G. Kennedy, Thomas Oscar Clanton, Steven Bayer, Guillaume Robert, Christian J. A. van Bergen, David O. Osei-Hwedieh, Gregory C. Berlet, Simon Görtz, Kamran S. Hamid, Monika Volesky, G McCollum, Chayanin Angthong, Sameh A. Labib, Eric I. Ferkel, Niall A. Smyth, Christopher D. Murawski, Charles Patrick Hannon, Martin Sullivan, Daniël Haverkamp, Benjamin B. Rothrauff, Carol L. Andrews, Richard D. Ferkel, Dominic S. Carreira, Jari Dahmen, Alberto Marangon, Adam Popchak, Tanawat Vaseenon, Alexander Tham, Kaj T. A. Lambers, Mallory Ehlers, Eric Giza, David B. Thordarson, Helene Simpson, Malcolm E. Dombrowski, Jeffrey S. Ling, Raluca Nicolescu, Stephen R. Kearns, Marcelo P. Prado, Raymond C. Walls, László Hangody, Adam W. Mitchell, Siu Wah Kong, Amgad M. Haleem, Jochen Paul, Keun Bae Lee, Mikel L. Reilingh, Carolyn M. Sofka, James W. Stone, Paloma Gauthier, Martin O'Malley, MaCalus V. Hogan, Jorge Batista, Lorraine AT Boakye, Jay Hertel, Cristian Ortiz, Pim A.D. van Dijk, Helder Pereira, Pietro Spennacchio, Mark Glazebrook, Francesca Vannini, Steven M. Raikin, Christopher J. Pearce, Kirk McCullough, Samuel B. Adams, Onno L. Baur, Martin Wiewiorski, Mohamed Gomaa, Rohan Phadke, C. Niek van Dijk, Lew C. Schon, Rocky Tuan, Roberto Buda, James A. Nunley, Eoghan T. Hurley, Jin Woo Lee, Philipp Niemeyer, Arianna L. Gianakos, Beat Hintermann, Christoph Becher, Gino M. M. J. Kerkhoffs, Hajo Therman, Gian L. Canata, James D. F. Calder, Christopher W. DiGiovanni, Hak Jun Kim, Pieter D’Hooghe, Kenneth J. Hunt, Umile Giuseppe Longo, Jared Rubin, James J. Butler, Yasuhito Tanaka, Victor Valderrabano, Sebastian Krebsbach, Stefan Nehrer, Markus Walther, Xiangyang Xu, Masato Takao, Jon Karlsson, Paulo N. F. Ferrao
article en

Abstract

BackgroundThe evaluation of osteochondral lesions of the talus (OLT) has long been limited by variability in imaging protocols, lesion measurement techniques, and clinical utility of radiographic classification systems. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the work-up, diagnostic imaging, and radiographic classification systems for OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory 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%).ResultsIn total, 19 consensus statements were achieved across the 3 meetings. Strong agreement was reached for first-line use of weight-bearing radiographs and complementary use of magnetic resonance imaging (MRI) and computed tomography for lesion characterization. Standardized assessment of lesion size in 3 planes and localization using a 9-zone grid were endorsed. Diagnostic arthroscopy was considered to have limited routine value in the setting of advanced imaging. Post-treatment imaging recommendations clarified indications for radiographs and cross-sectional imaging and emphasized the limited correlation between imaging findings and clinical function. Computed tomography-based classification systems were considered more useful for guiding treatment decisions than plain radiographic or MRI-based systems.ConclusionThese international consensus statements establish a standardized imaging-based framework for the evaluation and classification of OLT, improving consistency in diagnosis, treatment planning, and clinical reporting.

Foot & Ankle Specialist
Semmelweis University (HU), Hospital for Special Surgery (US), Cedars-Sinai Medical Center (US), Rush University Medical Center (US), Dalhousie University (CA), Universität für Weiterbildung Krems (AT), Harvard University (US), Cairo University (EG), Emory University (US), University of Cape Town (ZA), Centre Hospitalier de Luxembourg (LU), University of Pittsburgh (US), Duke University (US), University of the Witwatersrand (ZA), Yonsei University (KR), Korea University (KR), Medical College of Wisconsin (US), Hospital Israelita Albert Einstein (BR), Sahlgrenska University Hospital (SE), University Medical Center Freiburg (DE), Ruijin Hospital (CN), Clínica Alemana (CL), Jewish General Hospital (CA), Slotervaartziekenhuis (NL), MedStar Union Memorial Hospital (US), University Hospital Galway (IE), Yale University (US), University of Chieti-Pescara (IT), Clínica Las Condes (CL), NYU Langone Health (US), Massachusetts General Hospital (US), Kantonsspital Baselland (CH), Chonnam National University Hospital (KR), Memorial Healthcare System (US), UPMC Health System (US), Kisarazu Hospital (JP), Kantonsspital Winterthur (CH), Institute of Chemical and Engineering Sciences (SG), Amphia Ziekenhuis (NL), Amsterdam Neuroscience (NL), Prince of Wales Hospital (AU), Orthopedic Foot & Ankle Center (US), Ospedale Koelliker (IT), Istituto Ortopedico Rizzoli (IT), St Vincent's Clinic (AU), Centro Hospitalar de Lisboa Ocidental (PT), Duke Medical Center (US), Steadman Philippon Research Institute (US), University of Pittsburgh Medical Center (US), Campus Bio Medico University Hospital (IT), Rothman Institute (US), Amsterdam University Medical Centers (NL), Southern California Orthopedic Institute (US), Duke University Hospital (US), Peachtree Orthopaedic Clinic (US), Carolina Musculoskeletal Institute (US), Fortius Clinic (GB), Mercy Medical Center (US), Chiang Mai University (TH), University of Virginia (US), Nara Medical University (JP), Albany Medical Center Hospital (US), University of Pennsylvania (US), Ludwig-Maximilians-Universität München (DE), University of California, Davis (US), University of Oklahoma (US), University of Amsterdam (NL), University of Colorado Denver (US)
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