Kon Elizaveta, Papakostas Emmanuel, Andriolo Luca, Serner Andreas, Massey Andrew, Verdonk Peter, Angele Peter, Arias Claudia, Kaleka Camila Cohen, Cugat Ramon, D'Hooghe Pieter, Della Villa Francesco, Eirale Cristiano, Erggelet Christoph, Espregueira-Mendes João, Fink Christian, Geertsema Celeste, Geertsema Liesel, Lee Cassandra A, Mandelbaum Bert, Nakamura Norimasa, Parker David A, Sas Kristof, Sonnery-Cottet Bertrand, van der Merwe Willem, Williams Andy, Zaffagnini Stefano, Zikria Bashir Ahmed, Filardo Giuseppe
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Br J Sports Med. 2025 Jun 18;59(13):902-911. doi: 10.1136/bjsports-2024-108960.
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 cm 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.
膝关节软骨损伤在足球运动员中很常见，但缺乏手术治疗的证据。本国际软骨再生与关节保护协会、国际足球联合会和阿斯佩塔尔（ICRS-FIFA-Aspetar）共识的目的是就竞技足球运动员有症状的膝关节软骨损伤采用非手术或手术治疗的适宜性制定基于专家意见、针对患者的具体实用建议。采用了兰德/加州大学洛杉矶分校适宜性方法，17位投票专家就96种不同临床场景下手术治疗的适宜性提供了建议，这些场景由6个变量定义：软骨损伤发作、损伤部位、缺损大小、骨受累情况、运动员症状水平以及对快速重返赛场或长期效果更高优先级的偏好。在32%的场景中，软骨损伤的手术治疗被认为是适宜的，21%的场景中不适宜，而在47%的场景中，适宜性被认为不确定。足球运动员软骨损伤手术治疗适宜性最高的参数是无法参赛（75.0%的适宜场景）、损伤大小为2厘米或更大（47.9%的适宜场景）以及运动员对长期效果的偏好（41.7%的适宜场景）。在这份ICRS-FIFA-Aspetar专家共识中，竞技足球运动员软骨损伤的手术治疗仅在三分之一的临床场景中被认为是适宜的，选择主要由症状水平驱动。手术偏好还受到较大损伤、累及软骨下骨的髁和滑车损伤以及运动员对长期效果的偏好的影响。
