History, Physical Examination, and Terminology of Osteochondral Lesions of the Talus: Proceedings of the International Congress on Cartilage Repair of the Ankle.

Abstract

BackgroundOsteochondral lesions of the talus (OLT) remain challenging to evaluate and report because of historically inconsistent terminology and nonspecific clinical findings. The 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle addressed complementary aspects of OLT evaluation, including history, physical examination, and terminology. The purpose of this proceedings article is to integrate these consensus statements into a concise framework for clinicians and researchers.MethodsSelected statements from the 2017 and 2019 International Consensus Meetings were reviewed and synthesized. Both meetings used a modified Delphi consensus process involving international experts in ankle cartilage repair. Statements were developed through blinded electronic surveys, structured questionnaires, literature review, in-person discussion, and final anonymous voting. Consensus strength was defined as consensus, strong consensus, or unanimous agreement according to predefined voting thresholds.ResultsConsensus statements supported standardized terminology distinguishing subchondral bone lesions, chondral lesions, and OLT. Bone marrow stimulation was endorsed as an umbrella term for marrow-access procedures, and standardized terminology was recommended for autologous and allograft osteochondral transplantation. The panel also supported consistent reporting of subchondral edema, subchondral cysts, lesion area, diameter, depth, and injury chronicity. For clinical assessment, consensus supported documentation of activity level, symptom duration, trauma history, pain localization, mechanical symptoms, prior treatment, swelling, alignment, ankle range of motion, stability, and tenderness to palpation. Deep activity-related ankle pain, with or without swelling, was identified as the most important clinical feature suggesting a symptomatic ankle cartilage lesion.ConclusionThis proceedings article integrates terminology, history, and physical examination recommendations from the 2017 and 2019 International Consensus Meetings on Cartilage Repair of the Ankle. Standardized use of these definitions and clinical assessment elements may improve clinical communication, documentation, and consistency in research reporting.