Topic: Management of the isolated articular symptomatic cartilage defect in the adult knee

Venue: Royal College of Surgeons of Edinburgh

Time & Date: 09:30 to 17:00, Sunday 23 March 2014

Contact: Email for further details

Programme: Click to view

Dear Colleague

I am looking forward to welcoming you to this meeting and thank you for your commitment. I have been working with an experienced group facilitator, Phil Glanfield, to develop our agenda for the day and so this letter is from us. In it and its attachments you should find all the information you need.

Purpose: To arrive at an agreement about the most appropriate treatment for the surgical management of isolated symptomatic articular cartilage defects of the stable young adult knee that can be written up and published.

Rationale for this approach: there are multiple ways of intervening in this situation and they vary in cost and effectiveness. Research evidence is growing, demonstrating the advantages of certain approaches in specific situations but is not, as yet, comprehensive and conclusive. Decisions about the most appropriate intervention are based on the patient’s condition and circumstances, research evidence, cost effectiveness and clinical judgment. Because of the pressure on resources surgeons may be expected, encouraged, or required to use the cheapest intervention regardless of the patient’s circumstances.

A published consensus recommending ‘this approach in these circumstances’ will be influential in ensuring that more patients receive the most appropriate treatment for their circumstances. The power of the consensus statement will be affected by the extent of the consensus as well as the authority and credibility of the individual signatories.

Consensus statements and meetings

The Dutch Orthopaedic Association published a consensus statement on this topic in 2011 and a copy is attached (view).

In the Editorial of The Bone and Joint Journal (Vol. 95-B, No. 11, November 2013, 1441) Morgan-Jones and Haddad write:

‘The consensus principle is under used in the orthopaedic community, but has great potential in an era where many informed international voices should be heard. Such a tool may protect surgeons and patients from guidelines that are narrow in scope and potentially based on limited, flawed or biased data and opinions.

The principles of decision making by consensus are well known. There are four broad requirements. First, the consensus must be inclusive. As many members of the community must be involved as possible, and no expert in the field should be intentionally excluded. All parties are expected to participate fully and to contribute in a variety of roles to the final decision. Secondly, cooperation is essential. The participants need to build on each other’s suggestions and concerns to formulate recommendations that adhere to the published evidence and expertise of the parties involved. It is important not to ignore the minority. Thirdly, egalitarianism is important. The input of the loud expert should not be greater than that of their quieter colleague. Everyone should have an equal opportunity to amend or veto ideas. Fourthly and potentially most importantly, the goal of a consensus must remain orientated towards a solution. An effective decision making body works towards a common solution despite differences, collaboratively shaping proposals until they meet as many of the participants’ views and concerns as possible. That may, of course, mean that there is no clear consensus other than that there are residual unanswered questions.’

This meeting will reflect these principles and the plan for the day is set out in the attached agenda.

Looking forward to working with you on this important issues. Please be in touch if you have any questions or concerns.

Best wishes

Leela Biant & Phil Glanfield

 

The UK Cartilage Consensus Meeting is supported by an unrestricted grant from The Scottish Orthopaedic Research Trust into Trauma (SORT-iT). SORT-iT is a charity that exists to promote education and research into care of the injured. The meeting is free to attend and refreshments and lunch is provided.

A separate industry-sponsored Tigenix dinner will be available to those who would like to avail themselves of this after the close of the consensus meeting. It is entirely independent of the consensus meeting. 

Lunch and refreshments provided. Accommodation at the College hotel ‘Ten Hill Place‘ at delegate rate of £85 per night including breakfast available.