Surgical Intervention for Small Osteochondral Lesions (<1 cm): Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background 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.

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Journal
Foot & Ankle Specialist
Published
2026-10-29
DOI
https://doi.org/10.1177/19386400261485356
Primary Topic
Foot and Ankle Surgery
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article
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article

Surgical Intervention for Small Osteochondral Lesions (<1 cm): Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Lew Charles Schon, Rocky S. Tuan, Martin O’Malley, Stefan Nehrer et al.
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Foot & Ankle Specialist
Foot and Ankle Surgery
article

Surgical Intervention for Small Osteochondral Lesions (<1 cm): Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Lew Charles Schon, Rocky S. Tuan, Martin O’Malley, Stefan Nehrer, Mark Anthony Glazebrook, Peter N. Mittwede, Masato Takao, Beat Hintermann, Kenneth John Hunt, Jari Dahmen, James A. Nunley, Thomas Oscar Clanton, Markus Walther, David O. Osei-Hwedieh, Gregory C. Berlet, Simon Görtz, Kamran S. Hamid, Chayanin Angthong, Samuel Bruce Adams, Sameh A. Labib, Lorraine A. T. Boakye, Steven M. Raikin, Niall A. Smyth, Christopher D. Murawski, MaCalus Vinson Hogan, Laszlo Rudolf Hangody, Charles Patrick Hannon, Daniël Haverkamp, Alastair S. E. Younger, Pieter P. R. N. d’Hooghe, Benjamin B. Rothrauff, Youichi Yasui, Carol L. Andrews, Jay N. Hertel, Graham McCollum, C. Niek van Dijk, Richard D. Ferkel, Martin Sullivan, Pim A. D. van Dijk, Eoghan T. Hurley, Paulo N. F. Ferrao, Alberto Marangon, Víctor Valderrábano, Adam Popchak, Tanawat Vaseenon, Jorge Pablo Batista, Gian Luigi Canata, Martin J. Wiewiorski, Alexander Tham, John Karlsson, Kaj T. A. Lambers, Gino M. M. J. Kerkhoffs, Francesca Vannini, Roberto Buda, Umile Giuseppe Longo, Eric Giza, David B. Thordarson, Helene Simpson, Malcolm E. Dombrowski, Ichiro Yoshimura, Jeffrey S. Ling, Marcelo P. Prado, Christopher William DiGiovanni, Christoph Becher, Philipp Niemeyer, John G. Kennedy, Siu Wah Kong, Amgad M. Haleem, Jochen Paul, Keun Bae Lee, Mikel L. Reilingh, Hua Yinghui, Carolyn M. Sofka, James W. Stone, James J. Butler, Jared Rubin, Steve Bayer, Mohamed Gomaa, Xiangyang Xu, Jin Woo Lee, International Society for Cartilage Repair of the Ankle, Yasuhito Tanaka, Hak Jun Kim, Zijun Zhang
article en

Abstract

Background 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.

Foot & Ankle Specialist
Semmelweis University (HU), Chonnam National University (KR), Hospital for Special Surgery (US), Cedars-Sinai Medical Center (US), Brigham and Women's Hospital (US), Rush University Medical Center (US), Dalhousie University (CA), Loyola University Medical Center (US), Universität für Weiterbildung Krems (AT), Mercy Medical Center (US), Harvard University (US), University of British Columbia (CA), Cairo University (EG), Emory University (US), University of Cape Town (ZA), University of Pittsburgh (US), Duke University (US), Shanghai Jiao Tong University (CN), Yonsei University (KR), Fudan University (CN), Thomas Jefferson University Hospital (US), Hospital of the University of Pennsylvania (US), Queen Elizabeth II Health Sciences Centre (CA), Hospital Israelita Albert Einstein (BR), Sahlgrenska University Hospital (SE), University Medical Center Freiburg (DE), Ruijin Hospital (CN), Slotervaartziekenhuis (NL), UNSW Sydney (AU), Fukuoka University (JP), Magna Graecia University (IT), University of Chieti-Pescara (IT), NYU Langone Health (US), Massachusetts General Hospital (US), Kantonsspital Baselland (CH), Chonnam National University Hospital (KR), Schön Klinik München Harlaching (DE), Kantonsspital Winterthur (CH), Cleveland Clinic Florida (US), Prince of Wales Hospital (AU), Steadman Clinic (US), Orthopedic Foot & Ankle Center (US), Ospedale Koelliker (IT), Istituto Ortopedico Rizzoli (IT), St Vincent's Clinic (AU), Uzsoki Hospital (HU), München Klinik Harlaching (DE), Azienda Ospedaliero-Universitaria "Renato Dulbecco" (IT), University of Pittsburgh Medical Center (US), Campus Bio Medico University Hospital (IT), Rothman Institute (US), Ospedale SS. Annunziata (IT), Amsterdam University Medical Centers (NL), Southern California Orthopedic Institute (US), Fortius Clinic (GB), Loyola Medicine (US), Huashan Hospital (CN), Yonsei University Health System (KR), Cairo University hospitals (EG), Praxisklinik Rennbahn AG (CH), Korea University Guro Hospital (KR), Chiang Mai University (TH), University of Virginia (US), University of Colorado Anschutz Medical Campus (US), Nara Medical University (JP), Albany Medical Center Hospital (US), University of Pennsylvania (US), Ludwig-Maximilians-Universität München (DE), University of California, Davis (US), Teikyo University (JP), University of Amsterdam (NL), University of Bologna (IT)
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