Revision and Salvage Management of Failed Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Background Management of failed osteochondral lesions of the talus (OLTs) remains challenging due to limited comparative evidence guiding revision and salvage treatment. This proceedings summary presents the conclusions reached during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings for evaluating failure and selecting subsequent treatment. Methods Two meetings used a modified Delphi process involving blinded electronic surveys, literature review, in-person discussion, and anonymous final voting. The 2017 panel comprised 75 experts from 25 countries and 1 territory, with the same panel participated in 2025. Eight revision and salvage statements developed in 2017 were ratified in 2025, and 6 statements addressing failed primary bone marrow stimulation (BMS) were developed in 2025. Consensus strength was classified by percentage agreement. Evidence was graded using a scale ranging from randomized controlled trials or meta-analyses (A1/A2) to expert opinion or basic science (E). Results Of 14 statements, 6 achieved unanimous agreement, 7 strong consensus, and 1 consensus. Evidence grades were B2 for 10 statements, C for 1, and E for 3. The statement identifying lesion size as the main treatment determinant when alignment and stability are maintained achieved 69% agreement, representing modest consensus. Revision recommendations emphasized identifying the lesion as the symptom source and a cause of failure. Salvage was supported when further cartilage revision was unrealistic or progressive osteoarthritis was present. Consideration to use orthobiologics received unanimous agreement, but Grade E evidence. Conclusion These statements provide an expert-consensus framework for managing failed OLT. Prospective comparative studies are needed to clarify treatment selection and outcomes. Level of Evidence: V, expert consensus

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Foot & Ankle Specialist
Published
2026-11-05
DOI
https://doi.org/10.1177/19386400261503980
Primary Topic
Foot and Ankle Surgery
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article
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article

Revision and Salvage Management of Failed Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

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

Revision and Salvage Management of Failed Osteochondral Lesions of the Talus: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle

Lew Charles Schon, Rocky S. Tuan, Martin O’Malley, Arianna L. Gianakos, 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, Guillaume Robert, Christian J. A. van Bergen, David O. Osei-Hwedieh, Gregory C. Berlet, Simon Görtz, Kamran S. Hamid, Monika Volesky, Chayanin Angthong, Samuel Bruce Adams, Sameh A. Labib, Niek C. van Dijk, Lorraine A. T. Boakye, Steven M. Raikin, Eric I. Ferkel, 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, Carol L. Andrews, Jay N. Hertel, Graham McCollum, Richard D. Ferkel, Martin Sullivan, Pim A. D. van Dijk, Eoghan T. Hurley, Paulo N. F. Ferrao, Dominic S. Carreira, Alberto Marangon, Víctor Valderrábano, Adam Popchak, Tanawat Vaseenon, Jorge Pablo Batista, Gian Luigi Canata, Martin J. Wiewiorski, Alexander Tham, Kirk A. McCullough, Kaj T. A. Lambers, Gino M. M. J. Kerkhoffs, Francesca Vannini, Hélder Pereira, Cristian A. Ortiz, Mallory Ehlers, Roberto Buda, Umile Giuseppe Longo, Eric Giza, David B. Thordarson, Helene Simpson, Malcolm E. Dombrowski, Kong Siu-Wah, Jeffrey S. Ling, Raluca Nicolescu, Stephen R. Kearns, Pietro Spennacchio, Marcelo P. Prado, Christopher William DiGiovanni, Christoph Becher, Philipp Niemeyer, John G. Kennedy, Adam W. Mitchell, Amgad M. Haleem, Jochen Paul, James D. F. Calder, Keun Bae Lee, Mikel L. Reilingh, Hajo Thermann, Christopher Jon Pearce, JON LÖVE KARLSSON, Carolyn M. Sofka, James W. Stone, Cian Walls, Sebastian Krebsbach, Paloma Gauthier, James J. Butler, Alexandra Brown, Jared Rubin, Stephen Bayer, Mohamed Gomaa, Rohan Phadke, Jin Woo Lee, Yasuhito Tanaka, Hak Jun Kim
article en

Abstract

Background Management of failed osteochondral lesions of the talus (OLTs) remains challenging due to limited comparative evidence guiding revision and salvage treatment. This proceedings summary presents the conclusions reached during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings for evaluating failure and selecting subsequent treatment. Methods Two meetings used a modified Delphi process involving blinded electronic surveys, literature review, in-person discussion, and anonymous final voting. The 2017 panel comprised 75 experts from 25 countries and 1 territory, with the same panel participated in 2025. Eight revision and salvage statements developed in 2017 were ratified in 2025, and 6 statements addressing failed primary bone marrow stimulation (BMS) were developed in 2025. Consensus strength was classified by percentage agreement. Evidence was graded using a scale ranging from randomized controlled trials or meta-analyses (A1/A2) to expert opinion or basic science (E). Results Of 14 statements, 6 achieved unanimous agreement, 7 strong consensus, and 1 consensus. Evidence grades were B2 for 10 statements, C for 1, and E for 3. The statement identifying lesion size as the main treatment determinant when alignment and stability are maintained achieved 69% agreement, representing modest consensus. Revision recommendations emphasized identifying the lesion as the symptom source and a cause of failure. Salvage was supported when further cartilage revision was unrealistic or progressive osteoarthritis was present. Consideration to use orthobiologics received unanimous agreement, but Grade E evidence. Conclusion These statements provide an expert-consensus framework for managing failed OLT. Prospective comparative studies are needed to clarify treatment selection and outcomes. Level of Evidence: V, expert consensus

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), Yale New Haven Hospital (US), Universität für Weiterbildung Krems (AT), Universidad del Desarrollo (CL), Mercy Medical Center (US), Harvard University (US), University of British Columbia (CA), Cairo University (EG), Emory University (US), University of Cape Town (ZA), Centre Hospitalier de Luxembourg (LU), University of Pittsburgh (US), Duke University (US), Yonsei University (KR), University of Michigan (US), 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), Clínica Alemana (CL), Jewish General Hospital (CA), Slotervaartziekenhuis (NL), University Hospital Galway (IE), UNSW Sydney (AU), Yale University (US), 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), Amphia Ziekenhuis (NL), 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), 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), Peachtree Orthopaedic Clinic (US), Fortius Clinic (GB), Loyola Medicine (US), University of California Davis Medical Center (US), Yonsei University Health System (KR), Cairo University hospitals (EG), Praxisklinik Rennbahn AG (CH), Korea University Guro Hospital (KR), Imperial College London (GB), 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), University of California, Davis (US), University of Amsterdam (NL), University of Colorado Denver (US), University of Bologna (IT)
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