Citations 2
Bridging Conservative Management With Injectable Orthobiologic Therapies: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle
Tham, Alexander, Rubin, Jared, Butler, James J., Gauthier, Paloma , Kennedy, John G. , Adams, Samuel B., Andrews, Carol L., Batista, Jorge , Baur, Onno L., Bayer, Stephen, Becher, Christoph, Berlet, Gregory C. , Boakye, Lorraine AT, Buda, R, Calder, James D. F., Dahmen, Jari , D’Hooghe, Pieter, DiGiovanni, Christopher W., Ehlers, M. , Ferkel, Richard D. , Ferkel, Eric, Ferrao, Paulo N. F., Giza, Eric , Gianakos, Arianna L., Glazebrook, Mark, Gomaa, Mohamed, Görtz, Simon, Haleem, Amgad M. , Hamid, Kamran S. , Hangody, László, Haverkamp, Daniel, Hertel, Jay, Hintermann, Beat, Hogan, MaCalus V., Hunt, Kenneth J., Hurley, Eoghan T., Karlsson, Jon, Kearns, Stephen R. , Kerkhoffs, Gino M. M. J., Kim, Hak Jun , Kong, Siu Wah, Krebsbach, Sebastian, Labib, Sameh A. , Lambers, Kaj T. A. , Lee, Jin Woo, Lee, Keun Bae, Ling, Jeffrey S., Longo, Umile Giuseppe, Marangon, Alberto, McCollum, G, McCullough, Kirk, Mittwede, Peter N. , Murawski, Christopher D. , Nicolescu, Raluca, Niemeyer, Philipp, Nunley, James A., O'Malley, Martin, Ortiz, Cristian, Osei-Hwedieh, David O. , Paul, Jochen , Pearce, Christopher J., Pereira, Hélder , Phadke, Rohan , Prado, Marcelo P. , Raikin, Steven M., Reilingh, Mikel L., Robert, Guillaume , Lc, Schon, Simpson, Helene, Smyth, Niall A. , Sofka, Carolyn M., Spennacchio, Pietro, Stone, James W., Takao, M, Tanaka, Yasuhito, Thermann, Hajo, Thordarson, David B. , Rs, Tuan, Valderrabano, Victor, Bergen, Christian J. A. van, Dijk, Pim A. D van, Dijk, Niek van, Vannini, Francesca, Vaseenon, Tanawat , Volesky, Monika , Walls, Raymond C., Walther, Markus, Wiewiorski, Martin, Xu, Xiangyang, Yasui, Youichi , Yinghui, Hua, Yoshimura, Ichiro, Younger, Alastair , Zdanowicz, Urszala, Zhang, Zijun, Adams, Samuel B. , Clanton, Thomas O , Dahmen, Jari , Ehlers, Mallory , Hannon, Charles P , Labib, Sameh A , Popchak, Adam , Robert, Guillaume , Smyth, Niall A , Tham, Alexander , Rubin, J Peter , Butler, James J., Angthong, Chayanin , Becher, Christoph, Boakye, Lorraine A. T. , Buda, Roberto , Calder, James D. F. , Canata, Gian Luigi , Carreira, Dominic S. , Dahmen, Jari , d’Hooghe, Pieter P. R. N. , DiGiovanni, Christopher William , Dombrowski, Malcolm E. , Ferkel, Eric I. , Ferrao, Paulo N. F. , Gianakos, Arianna L. , Glazebrook, Mark Anthony , Gomaa, Mohamed, Hannon, Charles P. , Haverkamp, Daniël , Hintermann, Beat , Hogan, MaCalus Vinson , Hunt, Kenneth John , Hurley, Eoghan T. , Karlsson, Jon, Kerkhoffs, Gino M. M. J. , Krebsbach, Sebastian , Lee, Jin Woo , Longo, Umile Giuseppe , Mitchell, Adam W. , Nehrer, Stefan , Niemeyer, Philipp , Nunley, James A. , O’Malley, Martin , Pearce, Christopher Jon , Pereira, Hélder , Raikin, Steven M. , Rothrauff, Benjamin B. , Schon, Lew Charles , Spennacchio, Pietro , Sullivan, Martin, Tanaka, Yasuhito , Valderrábano, Víctor , Dijk, Pim A. D. van , Vannini, Francesca , Walther, Markus , Wiewiorski, Martin J., Xu, Xiangyang , Yoshimura, Ichiro , Zhang, Zijun
Foot & Ankle Specialist | July 24, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background The management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. 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 role of conservative management and injectable orthobiologic strategies in the treatment of OLT. Methods Seventy-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%) Results In total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counseling Conclusion These international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.
Suture Button Fixation Treatment of Chronic Lisfranc Injury in Professional Dancers and High-Level Athletes
Charlton, Timothy P., Boe, Chelsea C., Thordarson, David B. , Boe, Chelsea
Journal of Dance Medicine & Science | December 4, 2015 | Volume: 19 | Issue: 4 | Pages: 135-139
Chronic Lisfranc injury is a subtle and severe injury in high-level athletes, including dancers. This patient population is generally intolerant of intra-articular screw fixation and can develop significant post-traumatic arthritis with potentially career ending complications. Flexible fixation with suture-button devices provides potential restoration of physiologic motion at the joint, with appropriate support for healing that may facilitate return to en pointe activities for dancers. We hypothesized that the suture-button device would restore motion at the Lisfranc joint and allow for return to activities in this particular population without the limitations and complications of rigid fixation. We operated on seven dancers and high-level athletes with diagnosed Lisfranc injuries by installing a suture-button device. All patients had failed conservative management after late presentation. They were allowed to return to sport in 6 months, preoperative and postoperative American Orthopaedic Foot and Ankle Score (AOFAS) foot scores were obtained, and patients were followed for a minimum of 15 months. All seven returned to full activities in 6 months, with radiographic evidence of fixation and no complications to date. AOFAS foot scores improved from an average of 65 preoperatively to an average of 97 postoperatively at latest follow-up. It is concluded that flexible fixation with suture-button type device represents a viable alternative to screw fixation or fusion that may allow dancers and athletes to return to previous levels of activity after Lisfranc injury. This case series represents to our knowledge the first application of this device to a unique population that requires flexibility at the Lisfranc joint for performance.