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Martin Krismer Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria

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survival rates. He feels responsible for his patients, and is also amenable to the law. He would be rather hesitant to give a recommendation to continue rock climbing after THA. The surgeon wants to base his recommendation on good evidence, but the

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Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Copenhagen, Denmark
Department of Clinical Medicine, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Thomas M Grupp Aesculap AG Research & Development & Medical Scientific Affairs, Tuttlingen, Germany
Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany

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Rob GHH Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
Technical University Delft, Delft, the Netherlands

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Luca Cristofolini Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy

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Anne Lübbeke Division of Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Switzerland
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

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Marcus Jäger Department of Orthopaedics, Trauma & Reconstructive Surgery St. Marien Hospital Mülheim an der Ruhr & Chair of Orthopaedics and Trauma Surgery University of Duisburg–Essen, Essen, Germany

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Matthias Fink TÜV Süd Product Service GmbH, Clinical Centre of Excellence, Munich Germany

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Sabine Rusch Aesculap AG Research & Development & Medical Scientific Affairs, Tuttlingen, Germany

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Hassan Achakri Zimmer Biomet, Clinical, Regulatory & Quality Affairs, Winterthur, Switzerland

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Francesco Benazzo IUSS Pavia, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

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Dario Bergadano Medacta International SA, Medical Affairs, Castel San Pietro, Switzerland

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Georg N Duda Julius Wolff Institute and Center for Muskuloskeletal Surgery, Berlin Institute of Health at Charité Universitätsmedizin Berlin, Germany

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Christian Kaddick EndoLab Mechanical Engineering GmbH, Riedering, Germany

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Volkmar Jansson Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany

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Klaus-Peter Günther University Clinic Carl Gustav Carus, Center for Orthopaedic & Trauma Surgery, Technical University Dresden, Dresden, Germany

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strategies or innovative implants must strictly follow rules of proper evaluation, regulation and training in order not to put patients at unnecessary risk ( 2 , 3 , 4 ). Although different recommendations regarding ‘phased’ or ‘stepwise’ introduction of

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Keith Tucker Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK

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Klaus-Peter Günther University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany

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Per Kjaersgaard-Andersen Department of Orthopaedics, Vejle Hospital, South Danish University, Vejle, Denmark

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Jörg Lützner University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany

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Jan Philippe Kretzer Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany

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Rob G.H.H. Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands

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Toni Lange Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany

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Luigi Zagra IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy

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aspects of these practices and to produce guidance for the benefit of patients, surgeons, manufacturers and regulators. In this article we will attempt to clarify and suggest recommendations around the issues of off-label, including discussing the mixing

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Markus Walther Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Brettreichstraße, Würzburg, Germany
Paracelsus Medizinische Privatuniversität, Strubergasse, Salzburg, Austria
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany

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Oliver Gottschalk Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany

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Matthias Aurich Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), DOUW - Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Grube-Straße, Halle, Germany
BG-Klinikum Bergmannstrost Halle, Halle, Saale, Germany

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Orthopedics and Traumatology (DGOU) published the first recommendation for treating osteochondral lesions of the talus ( 1 ). As much further research has been done within the last 6 years, the rationale behind the update was to include recent results and the

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Pablo Castillón Department of Trauma and Orthopaedic Surgery, Hospital, Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain

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Josep Maria Muñoz Vives Department of Trauma and Orthopaedic Surgery, Hospital Althaia Manresa. Manresa, Barcelona, Spain
Department of Trauma and Orthopaedic Surgery, Hospital Nostra Senyora de Meritxell, Andorra

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Héctor José Aguado Department of Trauma and Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid. Valladolid, Spain
Universidad de Valladolid, Valladolid, Spain

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Arantxa Capel Agundez Department of Trauma and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain

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Alina Ortega-Briones Department of Trauma and Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid. Valladolid, Spain

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Jorge Hassan Núñez Department of Trauma and Orthopaedic Surgery, Hospital, Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain

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the PISCO Investigators †
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the PISCO Investigators

fracture? No consensus was reached. Half of the delegates considered appropriate to include a recommendation about this topic, but the other half did not. Strong consensus was reached about the fourth principle statement (95% agreement) in the last

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Alli Gokeler University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands

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Bart Dingenen Rehabilitation Research Institute, Biomedical Research Institute, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium

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Caroline Mouton Département de l’Appareil Locomoteur, Centre Hospitalier de Luxembourg – Clinique d’Eich, 76, rue d’Eich, L-1460 Luxembourg, Luxembourg

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Romain Seil Département de l’Appareil Locomoteur, Centre Hospitalier de Luxembourg – Clinique d’Eich, 76, rue d’Eich, L-1460 Luxembourg, Luxembourg and Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d’Eich, L-1460 Luxembourg, Luxembourg

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importance of establishing registries on a national basis has been advocated by Scandinavian authors to analyse the outcome after ALCR. 9 , 10 In many European countries, such registries are not available. Following these recommendations, clinical

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Christiaan J A van Bergen Department of Orthopedic Surgery, Amphia, Breda, the Netherlands

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Pieter Bas de Witte Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands

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Floor Willeboordse Knowledge Institute of Medical Specialists, Utrecht, the Netherlands

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Babette L de Geest Knowledge Institute of Medical Specialists, Utrecht, the Netherlands

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Magritha (Margret) M H P Foreman-van Drongelen Department of Hip Sonography, Diagnostiek voor U, Eindhoven, the Netherlands

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Bart J Burger Department of Orthopedic Surgery, North West Hospital Group, Alkmaar, the Netherlands

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Yvon M den Hartog Department of Orthopedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands

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Joost H van Linge Department of Orthopedic Surgery, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands

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Renske M Pereboom Dutch Hip Patient Association, Vereniging Afwijkende Heupontwikkeling, Nijkerk, the Netherlands

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Simon G F Robben Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands

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M Adhiambo Witlox Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands

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Melinda M E H Witbreuk Department of Orthopedic Surgery, OLVG, AUMC, Amsterdam, the Netherlands

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relevant medical professionals and the Dutch hip patient association. The aim was to provide recommendations for the best possible and uniform treatment of DDH. Part 1 of this guideline, as described in the current article, focuses on treatment of centered

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James Wee Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore

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Gowreeson Thevendran Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore

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rates, time to graft incorporation, and complication rates in both the paediatric and adult populations, warranting a Grade B recommendation for the use of allografts as an alternative to autografts. However, it should be noted that the literature is

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Mattia Loppini Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy

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Francesco Manlio Gambaro Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

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Rob G H H Nelissen Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Guido Grappiolo IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy

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relevance of a study, the following inclusion criteria were adopted: information from original papers, an orthopedic society guideline or a regulatory agency recommendation, the inclusion of information on duration and frequency of the follow-up visits after

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Pieter Bas de Witte Department Orthopedic Surgery, LUMC, Leiden, the Netherlands

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Christiaan J A van Bergen Department Orthopedic Surgery, Amphia, Breda, the Netherlands

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Babette L de Geest Knowledge Institute of Medical Specialists, Utrecht, the Netherlands

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Floor Willeboordse Knowledge Institute of Medical Specialists, Utrecht, the Netherlands

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Joost H van Linge Juliana Children’s Hospital, The Hague & Reinier HAGA Orthopaedic Centre, Zoetermeer and Delft, the Netherlands

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Yvon M den Hartog Department Orthopedic Surgery, MST, Enschede, the Netherlands

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Magritha (Margret) M H P Foreman-van Drongelen Department Hip Sonography, Diagnostiek voor U, Eindhoven, The Netherlands

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Renske M Pereboom Dutch Hip Patient Association “Vereniging Afwijkende Heupontwikkeling”, Nijkerk, the Netherlands

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Simon G F Robben Department Radiology, Maastricht University Medical Center, Maastricht, the Netherlands

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Bart J Burger Department Orthopedic Surgery, North West Hospital Group, Alkmaar, the Netherlands

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M Adhiambo Witlox Department Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands

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Melinda M E H Witbreuk Department Orthopedic Surgery OLVG, AUMC Amsterdam, the Netherlands

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Committee had meetings on a regular basis. Decisions and final recommendations were made by consensus, and all members of the committee agreed on the final contents of the guideline. Guideline questions During preparative phase, key issues were

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