Fixation for knee cartilage injuries—an international Delphi consensus statement

Introduction

Articular cartilage injuries of the knee are a complex and challenging clinical pathology.

Objectives

The purpose of this study was to establish consensus statements via a Delphi process on cartilage fixation techniques and indications.

Methods

A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Fourteen questions were generated on cartilage fixation, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement.

Results

Of the 14 total questions and consensus statements on cartilage fixation developed from 3 rounds of voting, 0 achieved unanimous consensus, 8 achieved strong consensus, 3 achieved consensus, and 3 did not achieve consensus.

Conclusions

The statements achieving strong consensus related to indications and contraindications, the expectation that younger patients experience better outcomes, and an agreement that procedures should be done as soon as possible but no limit on timeframe, cartilage preparation techniques, and the use of fragment stability to guide cartilage fixation techniques. The statements that did not achieve consensus related to the minimum size of cartilage fragments that can be fixed, if purely cartilaginous lesions can be fixed, and the fixation techniques.