SLARD consensus for the treatment of focal chondral lesions of the knee

Abstract

ObjectivesTo establish a consensus of the Latin American knee surgeons from SLARD for treating focal chondral lesions of the knee. MethodsA formal consensus was conducted among three groups of surgeons from the Latin American society of arthroscopy (SLARD) with special interest in cartilage. First, the steering group (n=9), created a list of 21 statements on controversial topics and compiled a review of literature for each topic. Secondly, the rating group (n=19), gave a score to each statement according to their agreement with it, over two rounds (score: 1-9). Median scores and agreement levels were calculated and each statement was categorized as inappropriate, uncertain or appropriate. Finally, the lecture group (n=24), evaluated the appropriateness and clinical relevance for each statement. ResultsDuring the first round, there was strong agreement on 5% of the statements, relative agreement on 14% and lack of consensus on 81% of statements. After the second round, there was strong agreement on 57% of statements, with 43% having relative agreement and no statement having a lack of consensus. The lecture group approved all the statements. ConclusionSLARD arrived at a consensus on the 21 statements proposed. This consensus includes literature review and clinical experience, which represents the expert opinion of a society. Strong agreement was found in the advantage of using arthroscopy to diagnose chondral lesions, pre-injury level as an age modification of treatment, superiority of nanofractures compared to microfractures, advantages of adding scaffolds, benefits of PRP in the midterm and faster return to sport with osteochondral autografts. Level of evidenceIV. What are the new findingsThis is the first formal consensus from SLARD about the treatment of focal chondral lesions of the knee.This consensus includes 55 orthopaedic surgeons from 13 countries in Latin America (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, México, Panama, Peru and Uruguay).This consensus about focal chondral lesions presents 21 statements in relation to the actual evidence, but also according to the Latin American context, available resources and experience.