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Consensus statement
ICRS-FIFA-Aspetar consensus on the management of knee cartilage injuries in football players: part 1 – appropriateness of surgery in different clinical scenarios using the RAND/UCLA appropriateness method
  1. Elizaveta Kon1,2,
  2. Emmanuel Papakostas3,
  3. Luca Andriolo4,
  4. Andreas Serner5,
  5. Andrew Massey6,
  6. Peter Verdonk3,7,8,
  7. Peter Angele9,10,
  8. Claudia Arias11,12,
  9. Camila Cohen Kaleka13,
  10. Ramon Cugat14,15,
  11. Pieter D'Hooghe3,
  12. Francesco Della Villa16,
  13. Cristiano Eirale3,
  14. Christoph Erggelet17,
  15. João Espregueira-Mendes18,19,20,21,22,
  16. Christian Fink23,24,
  17. Celeste Geertsema3,
  18. Liesel Geertsema3,
  19. Cassandra A Lee25,
  20. Bert Mandelbaum26,
  21. Norimasa Nakamura27,
  22. David A Parker28,
  23. Kristof Sas7,29,
  24. Bertrand Sonnery-Cottet30,
  25. Willem van der Merwe31,
  26. Andy Williams32,
  27. Stefano Zaffagnini4,
  28. Bashir Ahmed Zikria3,
  29. Giuseppe Filardo33,34
  1. 1 IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
  2. 2 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
  3. 3 ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4 Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
  5. 5 FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
  6. 6 Medical and Anti Doping Department, Federation Internationale de Football Association, Zurich, Switzerland
  7. 7 ORTHOCA, Antwerp, Belgium
  8. 8 Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
  9. 9 Department of Trauma and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
  10. 10 Sporthopaedicum Regensburg, Regensburg, Germany
  11. 11 Hospital Edgardo Rebagliati Martins, Lima, Peru
  12. 12 Cirugia Especializada De Rodilla, Lima, Peru
  13. 13 Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
  14. 14 Mutualidad de Futbolistas Españoles - Delegación Catalana, Barcelona, Spain
  15. 15 Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
  16. 16 Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
  17. 17 Alphaclinic Zurich, Zurich, Switzerland
  18. 18 Clinica Espregueira - Fifa Medical Centre of Excellence, Porto, Portugal
  19. 19 Dom Henrique Research Centre, Porto, Portugal
  20. 20 School of Medicine, University of Minho, Braga, Portugal
  21. 21 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
  22. 22 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
  23. 23 Gelenkpunkt - Sports and joint surgery, Innsbruck, Austria
  24. 24 UMIT, Hall, Austria
  25. 25 Department of orthopaedic surgery, University of California Davis school of medicine, Sacramento, California, USA
  26. 26 Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
  27. 27 Osaka Health Science University, Osaka, Japan
  28. 28 Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
  29. 29 Royal Belgian Football Association, Tubize, Belgium
  30. 30 Chirurgie Orthopédique, Centre Orthopédique Santy, Hôpital privé Jean Mermoz, Lyon, France
  31. 31 Sport Science Istitute of SA, Cape Town, South Africa
  32. 32 Fortius Clinic, London, UK
  33. 33 Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  34. 34 Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
  1. Correspondence to Dr Luca Andriolo; lucas.andriolo{at}gmail.com

Abstract

Knee cartilage lesions are frequent in football players, but evidence for surgical treatment is lacking. The aim of this International Cartilage Regeneration & Joint Preservation Society, Fédération Internationale de Football Association, and Aspetar (ICRS-FIFA-Aspetar) consensus was to develop specific expert-based, patient-specific practical recommendations on the appropriateness of non-surgical or surgical treatments for symptomatic knee cartilage lesions in competitive football players. The RAND/UCLA appropriateness method was used, and 17 voting experts provided recommendations on the appropriateness of surgical treatment in 96 different clinical scenarios defined on 6 variables: cartilage injury onset, lesion location, defect size, bone involvement, player symptom level and preference towards higher priority of a quick return to play or long-term results. Surgical treatment of a cartilage lesion was considered appropriate in 32% of the scenarios, in 21% inappropriate, while in 47% of the scenarios, the appropriateness was considered uncertain. The parameters with the highest appropriateness for the surgical treatment of a cartilage lesion in a football player were the inability to play (75.0% of appropriate scenarios), a lesion sized 2 cm2 or bigger (47.9% of appropriate scenarios) and the preference of the player for long-term results (41.7% of appropriate scenarios). In this ICRS-FIFA-Aspetar expert consensus, surgical treatment for cartilage injuries in competitive football players was considered appropriate only in one-third of the clinical scenarios, and the choice was mainly driven by the level of symptoms. Surgical preference was also influenced by larger lesions, lesions of the condyles and trochlea with subchondral bone involvement and player’s preference towards long-term results.

  • Football
  • Soccer
  • Cartilage
  • Knee
  • Consensus

https://doi.org/10.1136/bjsports-2024-108960

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    Footnotes

    • X @aserner, @andy_massey, @PdHooghe, @fdellavilla, @doccasslee

    • EK and EP contributed equally.

    • Contributors GF, EK, EP, AS, AM and PV: consensus design, scenarios' definition, final draft correction and approval; LA and GF: data analysis; LA: manuscript first draft writing; PA, CA, CCK, RC, PD'H, CEirale, JE-M, CF, CAL, BM, NN, DAP, BS-C, WvdM, AMW, SZ, BAZ, FDV, CErggelet, CG, LG and KS: data acquisition and interpretation, final draft correction and approval; LA: guarantor.

    • Funding The consensus project was endorsed by the Fédération Internationale de Football Association (FIFA) and by the International Cartilage Regeneration and Joint Preservation Society (ICRS). Aspetar Orthopaedic and Sports Medicine Hospital (Doha, Qatar) was involved in consensus organisation and hosted and funded the in-person meeting on 25 September 2023.

    • Competing interests EK reports consulting for Cartiheal, Green Bone, Geistlich and Bioveex, and speaking for Zimmer Biomet and Fidia Farmaceutici SPA. EP: General Board member ICRS, Editorial board JCJP, Advisory board Askel Healthcare, Lectures fees S&N, Lecture fees ConMedAS and AM declare full time employment by FIFA. PV: Royalties Conmed; Consultant Conmed, Adler, Geistlich, Symbios. PA: professorship: aesculap/tetec; consultant: aesculap, Arthrex; fifa: director fifa excellence centre regensburg. CF: Product Royalties and consulting agreement: Medacta, Karl Storz. CAL: Advisory Board: Vericel; Consultant: Smith and Nephew, Johnson and Johnson, Moximed. NN: Editorial Board, AJSM, JISAKOS, Cartilage, J Exp Orthop, J Orthops Sci; Institutional Research Support, Cell Source; Research Grant, Japan Agency for Medical Research and Development, Japan Society for the Promotion of Science DAP: editorial board of AJSM, JISAKOS, AP-SMART Journal, OJSM; hold shares in Peronalised Surgery, Ganymed Robotics; received royalties from Nil; done consulting work for Smith & Nephew; received institutional support from Smith & Nephew, Simmer, Corin, Arthrex. BS-C has received consulting fees and royalties from Arthrex. WvdM: Editorial board JISAKOS; Shareholder GRUCOX medical; Consultant S&N. AMW is on the editorial Board Member American Journal of Sports Medicine, is Share holder Innovate Orthopaedics, and share holder DocComs. SZ: consultant surgeon for Smith and Nephew and DePuy Synthes. The other authors declare no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.