History, Physical Examination, and Terminology of Osteochondral Lesions of the Talus: Proceedings of the International Congress on Cartilage Repair of the Ankle

BackgroundOsteochondral lesions of the talus (OLT) remain challenging to evaluate and report because of historically inconsistent terminology and nonspecific clinical findings. The 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle addressed complementary aspects of OLT evaluation, including history, physical examination, and terminology. The purpose of this proceedings article is to integrate these consensus statements into a concise framework for clinicians and researchers.MethodsSelected statements from the 2017 and 2019 International Consensus Meetings were reviewed and synthesized. Both meetings used a modified Delphi consensus process involving international experts in ankle cartilage repair. Statements were developed through blinded electronic surveys, structured questionnaires, literature review, in-person discussion, and final anonymous voting. Consensus strength was defined as consensus, strong consensus, or unanimous agreement according to predefined voting thresholds.ResultsConsensus statements supported standardized terminology distinguishing subchondral bone lesions, chondral lesions, and OLT. Bone marrow stimulation was endorsed as an umbrella term for marrow-access procedures, and standardized terminology was recommended for autologous and allograft osteochondral transplantation. The panel also supported consistent reporting of subchondral edema, subchondral cysts, lesion area, diameter, depth, and injury chronicity. For clinical assessment, consensus supported documentation of activity level, symptom duration, trauma history, pain localization, mechanical symptoms, prior treatment, swelling, alignment, ankle range of motion, stability, and tenderness to palpation. Deep activity-related ankle pain, with or without swelling, was identified as the most important clinical feature suggesting a symptomatic ankle cartilage lesion.ConclusionThis proceedings article integrates terminology, history, and physical examination recommendations from the 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle. Standardized use of these definitions and clinical assessment elements may improve clinical communication, documentation, and consistency in research reporting.

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Foot & Ankle Specialist
Published
2026-09-17
DOI
https://doi.org/10.1177/19386400261485355
Primary Topic
Foot and Ankle Surgery
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article
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article

History, Physical Examination, and Terminology of Osteochondral Lesions of the Talus: Proceedings of the International Congress on Cartilage Repair of the Ankle

Ian Savage-Elliott, John G. Kennedy, Steven Bayer, Yoshiharu Shimozono et al.
Foot & Ankle Specialist
Foot and Ankle Surgery
article

History, Physical Examination, and Terminology of Osteochondral Lesions of the Talus: Proceedings of the International Congress on Cartilage Repair of the Ankle

Ian Savage-Elliott, John G. Kennedy, Steven Bayer, Yoshiharu Shimozono, G McCollum, Christopher D. Murawski, Martin Sullivan, Daniël Haverkamp, Alastair Younger, Conor Mulvin, Youichi Yasui, Richard D. Ferkel, Jari Dahmen, Marcelo Pires Prado, Alexander Tham, Kaj T. A. Lambers, Eric Giza, David B. Thordarson, Stephen R. Kearns, Hélder Pereira, M. Shazil Jamal, László Hangody, Adam Mitchell, Jochen Paul, Hajo Thermann, MaCalus V. Hogan, Jorge Batista, Pietro Spennacchio, Mark Glazebrook, Gregory Berlet, Zakariya Ali, Francesca Vannini, Steven M. Raikin, Onno L. Baur, James W. Stone, Christopher DiGiovanni, C. Niek van Dijk, Lew C. Schon, Roberto Buda, Sjoerd A. S. Stufkens, Martin S. Davey, Christopher Pearce, Raymond J. Walls, Victor Valderrabano, Jin Woo Lee, Arianna L. Gianakos, James A. Nunley, Dominic Carreira, Beat Hintermann, James Calder, Masato Takao, Yinghui Hua, Daire Hurley, Pieter D’Hooghe, Kenneth J. Hunt, James J. Butler, Nathaniel P. Mercer, Jared Rubin, Christiaan J. A. van Bergen, J. Nienke J. Altink, Eoghan T. Hurley, James Toale, Members of International Consensus Group on Cartilage Repair of the Ankle 2017*, Jon Karlsson, Markus Walther, Gino M. M. J. Kerkhoffs
article en

Abstract

BackgroundOsteochondral lesions of the talus (OLT) remain challenging to evaluate and report because of historically inconsistent terminology and nonspecific clinical findings. The 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle addressed complementary aspects of OLT evaluation, including history, physical examination, and terminology. The purpose of this proceedings article is to integrate these consensus statements into a concise framework for clinicians and researchers.MethodsSelected statements from the 2017 and 2019 International Consensus Meetings were reviewed and synthesized. Both meetings used a modified Delphi consensus process involving international experts in ankle cartilage repair. Statements were developed through blinded electronic surveys, structured questionnaires, literature review, in-person discussion, and final anonymous voting. Consensus strength was defined as consensus, strong consensus, or unanimous agreement according to predefined voting thresholds.ResultsConsensus statements supported standardized terminology distinguishing subchondral bone lesions, chondral lesions, and OLT. Bone marrow stimulation was endorsed as an umbrella term for marrow-access procedures, and standardized terminology was recommended for autologous and allograft osteochondral transplantation. The panel also supported consistent reporting of subchondral edema, subchondral cysts, lesion area, diameter, depth, and injury chronicity. For clinical assessment, consensus supported documentation of activity level, symptom duration, trauma history, pain localization, mechanical symptoms, prior treatment, swelling, alignment, ankle range of motion, stability, and tenderness to palpation. Deep activity-related ankle pain, with or without swelling, was identified as the most important clinical feature suggesting a symptomatic ankle cartilage lesion.ConclusionThis proceedings article integrates terminology, history, and physical examination recommendations from the 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle. Standardized use of these definitions and clinical assessment elements may improve clinical communication, documentation, and consistency in research reporting.

Foot & Ankle Specialist
Semmelweis University (HU), Tulane University (US), Cedars-Sinai Medical Center (US), Mercy Medical Center (US), University of British Columbia (CA), Royal College of Surgeons in Ireland (IE), University of Cape Town (ZA), Centre Hospitalier de Luxembourg (LU), Yonsei University (KR), Kyoto University (JP), Fudan University (CN), Thomas Jefferson University Hospital (US), Queen Elizabeth II Health Sciences Centre (CA), Hospital Israelita Albert Einstein (BR), Franklin Institute (US), Sahlgrenska University Hospital (SE), Royal London Hospital (GB), University Hospital Galway (IE), Amsterdam UMC Location University of Amsterdam (NL), Mater Misericordiae University Hospital (IE), Yale University (US), University of Chieti-Pescara (IT), NYU Langone Health (US), Massachusetts General Hospital (US), Kantonsspital Baselland (CH), Amphia Ziekenhuis (NL), Orthopedic Foot & Ankle Center (US), Istituto Ortopedico Rizzoli (IT), St Vincent's Clinic (AU), Uzsoki Hospital (HU), University of Pittsburgh Medical Center (US), Rothman Institute (US), National University Health System (SG), Amsterdam University Medical Centers (NL), Southern California Orthopedic Institute (US), Duke University Hospital (US), Peachtree Orthopaedic Clinic (US), Fortius Clinic (GB), Huashan Hospital (CN), Mater Foundation, Centro Hospitalar Póvoa de Varzim Vila do Conde EPE, Albany Medical Center Hospital (US), Ludwig-Maximilians-Universität München (DE), University of California, Davis (US), Teikyo University (JP), University of Amsterdam (NL), University of Colorado Denver (US)
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Foot and Ankle Surgery
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