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Aims: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process., Methods: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous., Results: Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus., Conclusion: Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport., Competing Interests: S. L. Sherman reports royalties or licenses from CONMED Linvatec, consulting fees from Arthrex, BioVentus, JRF Ortho, Kinamed, Smith & Nephew, Vericel, CONMED Linvatec, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthex, Joint Restoration Foundation, Kinamed, Smith & Nephew, and Vericel, and stock or stock options from Epic Bio, Reparel, Sarcio, and Vivorte, all of which are unrelated to this study. J. Chahla reports consulting fees from Arthrex, CONMED Linvatec, Ossur, and Smith & Nephew, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Smith & Nephew, all of which are unrelated to this study. M. J. Alaia reports consulting fees from BodyCad, JRF Ortho, and Mitek, institutional grants from Orcosa, and royalties from Springer, all of which are unrelated to this study. M. J. Tanaka reports grants or contracts from FujiFilm, royalties or licenses from Verywell, and consulting fees from Depuy Synthes, all of which are unrelated to this study. J. L. Pace reports consulting fees from Arthrex and JRF Ortho, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, and stock or stock options from OutcomeMD, all of which are unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all of which are unrelated to this study., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach., Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous., Results: Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus., Conclusion: The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed., Competing Interests: D. Dejour reports royalties or licenses from Corin, Arthrex, and SBM and consulting fees from Smith & Nephew, all unrelated to this study. M. K. Mulcahey reports consulting fees from Arthrex, unrelated to this study. J. R. Wittstein reports consulting fees from Geistlich, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Vericel, stock or stock options from ViewFi Health, all unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, both related and unrelated to this study, royalties or licenses and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all unrelated to this study., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.