Table 7.
Statements, Grade of Recommendation, LOE of the Best Study on the Topic, and Agreement on the Statements Among the Experts.
| Statement | Grade of Recommendation | Highest LOE | Agreement Among the Experts (%) | ||||
|---|---|---|---|---|---|---|---|
| Totally Agree | Somehow Agree | Neither Agree nor Disagree | Somehow Disagree | Totally Disagree | |||
| The causes of OLTs are diverse. The predominant location is the central third of the medial talar dome. Many of the causative factors cannot be changed. However, remediating any causative factors should be part of the treatment concept, if possible. | B | III | 96 | 4 | 0 | 0 | 0 |
| The evaluation of hindfoot alignment, ankle stability, and range of motion should be part of the clinical assessment. | B | III | 92 | 8 | 0 | 0 | 0 |
| The standard assessment for evaluating cartilage lesions includes MRI to visualize bone edema and the cartilage in combination with weightbearing x-rays or WBCT. Traditional CT visualizes the bony pathology more precisely than MRI; however, it does not provide information on the mechanical axis and foot position under weightbearing conditions. Although many new MRI protocols have been published within the last few years, the sensitivity and specificity of MRI regarding cartilage lesions have limitations. | B | III | 85 | 11 | 4 | 0 | 0 |
| The descriptive classification system of Berndt and Harty, modified by Loomer, can still be recommended, as well as the Giannini Classification, ICRS Classification, and Outerbridge Classification. Especially for scientific studies, location and size should be documented, including the source of the measurements. | B | III | 85 | 15 | 0 | 0 | 0 |
| OLTs with minimal symptoms are unlikely to progress to OA, especially if the modification of activities leads to a symptom-free situation. Based on MRI findings alone, there is no need to urge patients with minimal or no symptoms for prophylactic surgery. After 12 months, a follow-up imaging with MRI prevents missing any asymptomatic progression of the lesion. | B | III | 85 | 15 | 0 | 0 | 0 |
| Reduction of activity is a strategy to reduce symptoms in OLTs. There is no evidence that cast immobilization leads to better results than reducing activities to a level with minimal or no symptoms. The overall success rate seems to be about 50%. There is only a limited correlation between the morphological appearance in imaging and the clinical symptoms. Surgery can be recommended if patients do not improve within 3 months of conservative management. | B | II | 73 | 27 | 0 | 0 | 0 |
| Injection therapy can improve pain and function in OLTs with PRP and HA demonstrating a similar positive effect on pain and functional scores. The effect extends approximately 6 months after injecting HA and 12 months after injecting PRP. | B | II | 42 | 42 | 8 | 8 | 0 |
| So far, there are no studies on shockwave as a standalone treatment option for OLTs. Focused ESWT can be considered a complementary treatment in patients with persistent pain after surgical treatment or adjunctive to stimulate tissue regeneration. | C | IV | 58 | 31 | 11 | 0 | 0 |
| Currently, no data are available to support the use of an electromagnetic field in treating OLTs in humans. | I | V | 81 | 4 | 15 | 0 | 0 |
LOE = level of evidence; OLT = osteochondral lesion of the talus; WBCT = weightbearing computed tomography; CT = computed tomography; ICRS = International Cartilage Regeneration and Joint Preservation Society; OA = osteoarthritis; PRP = platelet-rich plasma; HA = hyaluronic acid; ESWT = extracorporeal shockwave therapy.