Introduction of the Concept of Consensus Meeting

Need for consensus

Cartilage science is a new science. In span of less than 20 years, a variety of surgical and non-surgical modalities of the treatment have emerged worldwide. Some of the methods have been reproducible at different centers while some are not. Arthroscopy surgeons routinely get cartilage patients and their numbers are increasing. There is an urgent need to create awareness and establish a basic understanding from the available knowledge. There are thousands of papers that have been published on cartilage repair in last 20 years; but most are of a low level of evidence and have confusing or contradictory results. Indian Cartilage Society realized this unique problem related to Cartilage and decided to use its intellectual and financial resources to reach to some consensus.

Introduction of the Team Members

The 1^st ICS Consensus team comprised of ICS members from various parts of the country. A due care was taken to select members of different seniority and different institutional level of practice like senior and junior surgeons, surgeon working in a small private hospital vis-à-vis in a big teaching institute, surgeon dedicated to cartilage practice vis-à-vis surgeon doing less frequent cartilage surgeries etc. The purpose of this heterogeneous group was to take into account different working conditions, resources and ease of meeting a technically demanding surgery.

Dr Deepak Goyal, President and Founder of Indian Cartilage Society was the project director. Three teams were made for the most common modalities of cartilage repair surgeries; namely the ‘Microfracture (MF) team’, ‘Osteochondral Cylinder Transfer Techniques (OCT) team’ and ‘Autologous Chondrocyte Implantation (ACI) team. Dr Nicholas Antao, Dr Nishith Shah and Dr Deepak Goyal were respective team leaders. Dr Parvez Abraham Afzal, Dr Ujjwal Deliwala and Dr Vaibhav Bagaria supported these three respective teams as junior members. All the three teams were also supported by a cartilage histopathologist, Dr Anjali Goyal. There were certain deficiencies in the team selection of 1^st consensus meeting. A suitable team leader for the ‘Scaffold based Cartilage Treatment’ and ‘Drug Based Cartilage Repair’ teams could not be found and hence both the modalities were excluded. A suitable Cartilage MR-Radiologist and Cartilage-Physiotherapist also could not be found from its member database. ICS hopes to overcome these deficiencies in 2^nd ICS Consensus Meeting.

No Conflict Agreement/ Financial Disclosures

To avoid industrial and personal bias, each member was asked not to take any help from the industry. Members were even not allowed to talk to industry about this project and they were prohibited to ask for any help including even a literature support from the industry. Each member signed a ‘No-Conflict agreement’, a ‘Financial Disclosure’ and an agreement to remain stick to the terms and conditions of the project. None of the member received any financial/ logistic/ any help by any means from the industry or any other institute or any other organisation. To avoid any financial conflict, all the expenses were born exclusively by Indian Cartilage Society.

Methodology Used

The whole team was given common search engine and literature selection guidelines. Each member was asked to prepare the methodology of article’s selection and stick to the selected articles while doing the data analysis. A detailed data search was followed by online discussions amongst each team. A one day meeting was organised at Ahmedabad for the brain storming sessions and peer-reviewing of each other team’s consensus. Another round of online discussions and email exchanges took place to meet the challenges posed by the peer reviewing of data during the brain storming session. Present booklet is the outcome of these ‘online pre-consensus meetings’, ‘consensus meeting’ and ‘online post-consensus meetings’ amongst the team members. Team faced many problems in the data analysis because of lack of standard definitions in the literature, small number of high level studies and large number of case reports/ series, heterogeneous group of patients, different selection criteria and outcome criteria used in different studies etc. Hence a caution needs to be exercised while interpreting each data and the consensus.

The meeting took place on 21.9.2014 at Ahmedabad.

The outcome of the meeting was published as “ICS consensus” and was distributed to IAS and ICS members during inaugration ceremony of “Indian Arthroscopy Society Annual Meeing”, held at Hyderabad on 12.10.2014.