Jared Rubin, Alexander Tham, James J. Butler, Paloma Gauthier, Davis Hedbany, John G. Kennedy, Jorge Batista, Stephen Bayer, Gregory C. Berlet, Roberto Buda, James D. F. Calder, Jari Dahmen, Martin S. Davey, Christopher W. DiGiovanni, Pieter D’Hooghe, Richard D. Ferkel, Arianna L. Gianakos, Eric Giza, Mark Glazebrook, László Hangody, Daniel Haverkamp, Beat Hintermann, MaCalus V. Hogan, Kenneth J. Hunt, Eoghan T. Hurley, M. Shazil Jamal, Jón Karlsson, Stephen R. Kearns, Gino M. M. J. Kerkhoffs, Kaj T. A. Lambers, Jin Woo Lee, G McCollum, Nathaniel P. Mercer, Christopher D. Murawski, James A. Nunley, Jochen Paul, Christopher Pearce, Hélder Pereira, Marcelo P. Prado, Steven M. Raikin, Ian Savage-Elliott, Lew C. Schon, James W. Stone, Sjoerd A. S. Stufkens, Martin Sullivan, Masato Takao, Hajo Thermann, David B. Thordarson, Victor Valderrabano, Christian J. A. van Bergen, C. Niek van Dijk, Francesca Vannini, Raymond J. Walls, Markus Walther, Youichi Yasui, Hua Yinghui, Alastair Younger
Background Osteochondral lesions of the tibial plafond (OLTPs) are considerably less common than osteochondral lesions of the talus (OLT), and the terminology, prognostic factors, and treatment strategies for these lesions remain poorly characterized. Methods Experts participated in a structured Delphi-based consensus process during the International Consensus Meeting on Cartilage Repair of the Ankle (ICCRA) meeting held in 2019. Blinded surveys, structured questionnaires, literature review, and in-person discussions were used to develop and refine statements. Consensus strength was defined as consensus (51-74%), strong consensus (75-99%), or unanimous (100%). Results A total of 11 consensus statements were developed addressing terminology, prognostic factors, and management of OLTP, all of which achieved strong consensus. Unanimous agreement was reached on the terminology “osteochondral lesion of the tibial plafond.” Key prognostic factors included lesion characteristics, cystic changes, kissing lesions, and hindfoot alignment. Nonoperative treatment may be considered in asymptomatic or nondisplaced lesions, whereas surgical treatment may be indicated for symptomatic or progressive lesions. Bone marrow stimulation was recommended for small, non-cystic lesions; osteochondral transplantation was supported for larger or cystic lesions. Associated pathology such as kissing lesions and malalignment should be addressed concurrently, and salvage procedures may be considered in advanced cases. Conclusion These international consensus statements establish practical guidance for the assessment and management of OLTP by integrating current evidence with expert opinion. By outlining key prognostic considerations and treatment pathways, these recommendations aim to reduce variability in clinical practice and provide a foundation for future investigation in this challenging pathology. Level of Evidence: V, expert consensus