Alexander Tham, Jared Rubin, James J Butler, Paloma Gauthier, John G Kennedy, Samuel B Adams, Carol L Andrews, Chayanin Angthong, Jorge P Batista, Onno L Baur, Steven Bayer, Christoph Becher, Gregory C Berlet, Lorraine A T Boakye, Roberto Buda, James D F Calder, Gian L Canata, Dominic S Carreira, Thomas O Clanton, Jari Dahmen, Pieter D'Hooghe, Christopher W DiGiovanni, Malcolm E Dombrowski, Mallory Ehlers, Richard D Ferkel, Eric I Ferkel, Paulo N F Ferrao, Eric Giza, Arianna L Gianakos, Mark Glazebrook, Mohamed Gomaa, Simon Görtz, Amgad M Haleem, Kamran S Hamid, Laszlo Hangody, Charles P Hannon, Daniel Haverkamp, Jay Hertel, Beat Hintermann, MaCalus V Hogan, Kenneth J Hunt, Eoghan T Hurley, Jon Karlsson, Stephen R Kearns, Gino M M J Kerkhoffs, Hak Jun Kim, Siu Wah Kong, Sebastian Krebsbach, Sameh A Labib, Kaj T A Lambers, Jin Woo Lee, Keun Bae Lee, Jeffrey S Ling, Umile Giuseppe Longo, Alberto Marangon, Graham McCollum, Kirk McCullough, Adam W Mitchell, Peter N Mittwede, Christopher D Murawski, Stefan Nehrer, Raluca Nicolescu, Philipp Niemeyer, James A Nunley, Martin O'Malley, Cristian Ortiz, David O Osei-Hwedieh, Jochen Paul, Christopher J Pearce, Helder Pereira, Rohan Phadke, Adam Popchak, Marcelo P Prado, Steven M Raikin, Mikel L Reilingh, Guilluame Robert, Benjamin B Rothrauff, Lew C Schon, Helene Simpson, Niall A Smyth, Carolyn M Sofka, Pietro Spennacchio, James W Stone, Martin Sullivan, Masato Takao, Yasuhito Tanaka, Hajo Therman, David B Thordarson, Rocky Tuan, Victor Valderrabano, Christian J A van Bergen, Pim A D van Dijk, C Niek van Dijk, Francesca Vannini, Tanawat Vaseenon, Monika Volesky, Raymond C Walls, Markus Walther, Martin Wiewiorski, Xiangyang Xu, Youichi Yasui, Hua Yinghui, Ichiro Yoshimura, Alastair S E Younger, Urszala Zdanowicz, Zijun Zhang
BackgroundThe evaluation of osteochondral lesions of the talus (OLT) has long been limited by variability in imaging protocols, lesion measurement techniques, and clinical utility of radiographic classification systems. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the work-up, diagnostic imaging, and radiographic classification systems for OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%).ResultsIn total, 19 consensus statements were achieved across the 3 meetings. Strong agreement was reached for first-line use of weight-bearing radiographs and complementary use of magnetic resonance imaging (MRI) and computed tomography for lesion characterization. Standardized assessment of lesion size in 3 planes and localization using a 9-zone grid were endorsed. Diagnostic arthroscopy was considered to have limited routine value in the setting of advanced imaging. Post-treatment imaging recommendations clarified indications for radiographs and cross-sectional imaging and emphasized the limited correlation between imaging findings and clinical function. Computed tomography-based classification systems were considered more useful for guiding treatment decisions than plain radiographic or MRI-based systems.ConclusionThese international consensus statements establish a standardized imaging-based framework for the evaluation and classification of OLT, improving consistency in diagnosis, treatment planning, and clinical reporting.