Concomitant Procedures for Knee Cartilage Injuries – An International Delphi Consensus Statement

PURPOSE The purpose of this study was to establish consensus statements via a Delphi process on concomitant procedures for knee cartilage injuries. METHODS A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Twelve questions were generated on concomitant procedures, with three rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80-89% agreement, whereas strong consensus was defined as 90-99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. RESULTS Of the 12 total questions and consensus statements on concomitant procedures developed from three rounds of voting, none achieved unanimous consensus, five achieved strong consensus, five achieved consensus, and two did not achieve consensus. CONCLUSION The statements achieving consensus were primarily related to the tibiofemoral joint, meniscal insufficiency, and ligamentous stability. Concomitant procedures, including osteotomy, meniscal repair or transplantation, and ligamentous repair or reconstruction, should be performed with cartilage procedures for the most optimal outcome. The statements that did not reach consensus were related to the patellofemoral joint and unloading osteotomies in patients with normal alignment. Level of Evidence Level V Expert Opinion.