Society meets to gain international consensus on ankle cartilage injury repair

Consensus will help clinicians provide appropriate treatment of ankle articular cartilage injuries.

Injuries to the ankle cartilage are common and difficult to treat. To standardize the diagnosis and care of patients with ankle cartilage injuries, the International Society on Cartilage Repair of the Ankle will hold the International Consensus Meeting on Cartilage Repair of the Ankle on Nov. 17-18 at the University of Pittsburgh, in collaboration with University of Pittsburgh Medical Center.

“There is a great deal of controversy still on the best way to treat articular cartilage injuries, particularly in the ankle,” Richard D. Ferkel, MD, director of the sports medicine fellowship at Southern California Orthopedic Institute, told Orthopedics Today. “We have been trying over the years to develop newer techniques that may work for certain types of problems and ... in the past, there has not been a consensus on which treatment is the best in which situation.”

Richard D. Ferkel, MD
Richard D. Ferkel

First democratic consensus

In 2012, the International Society on Cartilage Repair of the Ankle (ISCRA) held its inaugural meeting in Dublin, which representatives from more than 40 countries attended.

“The initial meeting underscored the diverse opinions from world leaders in ankle cartilage treatment and so began the journey to come to a consensus to create a universal paradigm of treatment,” John G. Kennedy, MD, FRCS, of Hospital for Special Surgery, co-founder of ISCRA, told Orthopedics Today.

MaCalus V. Hogan, MD
MaCalus V. Hogan

Since 2012, the ISCRA has met five other times to present and debate cutting-edge research on ankle cartilage repair, he said.

There is informal consensus now, but the role of new techniques in the treatment armamentarium still needs to be determined, according to Ferkel.

“This will be the first truly democratic consensus from a diverse international panel of more than 100 medical professionals to guide the treatment of this challenging condition,” Kennedy said. “The outcomes will be published in both peer reviewed journals and in books so a diverse audience can be reached and change effected to improve outcomes for the future.”

John G. Kennedy, MD, FRCS
John G. Kennedy

A guideline is the goal

According to Ferkel, a year-long process based on the Delphi technique for establishing consensus involved study groups that developed and voted on the best way to handle diagnosis, conservative management with biologic treatment strategies and cartilage transplantation. Consensus will be achieved if everyone in a study group unanimously agrees on a given point. If any group members do not agree on a given point prior to the meeting, a formal discussion will take place at the November meeting, followed by a vote.

MaCalus V. Hogan, MD, chief of the division of foot and ankle surgery in the department of orthopedic surgery at University of Pittsburgh and local co-host of the meeting, told Orthopedics Today, “My hope is that we can walk away from this meeting with evidence and expert-driven algorithms that surgeons within any environment worldwide can utilize to help their patients with this difficult problem.”

Results of the consensus meeting will appear in Orthopedics Today in early 2018. – by Casey Tingle

Disclosures: Ferkel, Hogan and Kennedy report no relevant financial disclosures.

Injuries to the ankle cartilage are common and difficult to treat. To standardize the diagnosis and care of patients with ankle cartilage injuries, the International Society on Cartilage Repair of the Ankle will hold the International Consensus Meeting on Cartilage Repair of the Ankle on Nov. 17-18 at the University of Pittsburgh, in collaboration with University of Pittsburgh Medical Center.

“There is a great deal of controversy still on the best way to treat articular cartilage injuries, particularly in the ankle,” Richard D. Ferkel, MD, director of the sports medicine fellowship at Southern California Orthopedic Institute, told Orthopedics Today. “We have been trying over the years to develop newer techniques that may work for certain types of problems and ... in the past, there has not been a consensus on which treatment is the best in which situation.”

Richard D. Ferkel, MD
Richard D. Ferkel

First democratic consensus

In 2012, the International Society on Cartilage Repair of the Ankle (ISCRA) held its inaugural meeting in Dublin, which representatives from more than 40 countries attended.

“The initial meeting underscored the diverse opinions from world leaders in ankle cartilage treatment and so began the journey to come to a consensus to create a universal paradigm of treatment,” John G. Kennedy, MD, FRCS, of Hospital for Special Surgery, co-founder of ISCRA, told Orthopedics Today.

MaCalus V. Hogan, MD
MaCalus V. Hogan

Since 2012, the ISCRA has met five other times to present and debate cutting-edge research on ankle cartilage repair, he said.

There is informal consensus now, but the role of new techniques in the treatment armamentarium still needs to be determined, according to Ferkel.

“This will be the first truly democratic consensus from a diverse international panel of more than 100 medical professionals to guide the treatment of this challenging condition,” Kennedy said. “The outcomes will be published in both peer reviewed journals and in books so a diverse audience can be reached and change effected to improve outcomes for the future.”

John G. Kennedy, MD, FRCS
John G. Kennedy

A guideline is the goal

According to Ferkel, a year-long process based on the Delphi technique for establishing consensus involved study groups that developed and voted on the best way to handle diagnosis, conservative management with biologic treatment strategies and cartilage transplantation. Consensus will be achieved if everyone in a study group unanimously agrees on a given point. If any group members do not agree on a given point prior to the meeting, a formal discussion will take place at the November meeting, followed by a vote.

MaCalus V. Hogan, MD, chief of the division of foot and ankle surgery in the department of orthopedic surgery at University of Pittsburgh and local co-host of the meeting, told Orthopedics Today, “My hope is that we can walk away from this meeting with evidence and expert-driven algorithms that surgeons within any environment worldwide can utilize to help their patients with this difficult problem.”

Results of the consensus meeting will appear in Orthopedics Today in early 2018. – by Casey Tingle

Disclosures: Ferkel, Hogan and Kennedy report no relevant financial disclosures.