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Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “terminology for osteochondral lesions of the ankle” developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Forty-three international experts in cartilage repair of the ankle representing 20 countries were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed, and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus, 51%–74%; strong consensus, 75%–99%; unanimous, 100%. Results: A total of 11 statements on terminology and classification reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Definitions are provided for osseous, chondral and osteochondral lesions, as well as bone marrow stimulation and injury chronicity, among others. An osteochondral lesion of the talus can be abbreviated as OLT. Conclusions: This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle.

Background: An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held. Results: A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement). Conclusion: These consensus statements may assist clinicians in the management of these difficult clinical pathologies. Level of Evidence: Level V, mechanism-based reasoning.

There is a wide variety of treatments for disruption of the syndesmosis. There is also controversy as to which device should be used for fixation of the syndesmosis, how many devices should be used, how many cortices the screws should engage, and whether, when, and where the screws should be removed. We conducted a study to determine how orthopedic surgeons manage these injuries. In a survey, we asked orthopedic trauma and foot and ankle fellowship directors and members of the Orthopaedic Trauma Association and the American Orthopaedic Foot and Ankle Society how they routinely treated the syndesmotic injury component of Danis-Weber type C or Lauge-Hansen pronation-external rotation type IV ankle fractures. The overall response rate was 50% (77/153). Fifty-one percent of respondents routinely used 3.5-mm cortical screws, 24% routinely used 4.5-mm cortical screws, and 14% routinely used a suture fixation device. Forty-four percent of respondents routinely used 1 screw, 44% routinely used 2 screws, and the rest were undecided between 1 and 2 screws. Twenty-nine percent of respondents engaged 3 cortices with syndesmotic screws, and 67% engaged 4 cortices. Syndesmotic screws were routinely removed 65% of the time and left in place 35% of the time. Routine removal of syndesmotic screws was done in the operating room in 95% of cases; it was done at 3 months in 49% of cases, at 4 months in 37%, and at 6 months in 12%. The most common method for treating syndesmotic injuries was through use of 3.5-mm screws engaging 4 cortices routinely removed in the operating room at 3 months. Number of screws used to fix the syndesmosis, either 1 or 2, was evenly split.