Methodological Framework for Global Expert Consensus on Musculoskeletal Infection: Establishing the ICM 2025 Recommendations

Abstract

Study Design: Multiphase methodological framework for international consensus development. Objective: This study describes the structured methodology adopted by the International Consensus Meeting on Infection-ICM 2025 (Spine Section) to formulate globally endorsed recommendations in musculoskeletal infection. The initiative aimed to standardise best practices in prevention, diagnosis, and management through a collaborative, evidence-driven process. Methods: The consensus was developed through an 11-phase process spanning over 2 years, involving more than 100 global experts in orthopaedic infection. Phases included expert selection, question generation and ranking, systematic evaluation, literature synthesis, inter-delegate discussions, and a final face-to-face meeting. Recommendation statements were refined via iterative feedback and consensus-building techniques, including asynchronous dialogue and voting thresholds. Delegates were selected based on academic merit and regional representation, ensuring a diverse and multidisciplinary panel. Structured timelines ensured transparency and accountability across all phases. Results: The outcome was a series of actionable, context-sensitive recommendations, reflecting high-level agreement across diverse healthcare settings. The methodology facilitated consensus on complex infection scenarios where definitive evidence was lacking, incorporating expert judgment and current literature. Conclusion: The ICM 2025 (Spine Section) framework demonstrates a robust model for consensus development in orthopaedic surgery. Its transparent and scalable design ensures reproducibility for future topics requiring global guidance. This methodology sets a precedent for collaborative guideline generation in musculoskeletal care.