ICRS-FIFA-Aspetar consensus on the management of knee cartilage injuries in football players: part 2–appropriateness of specific surgical procedures to address articular cartilage lesions in different clinical scenarios using the RAND/UCLA appropriat

Knee articular cartilage lesions are frequent in football players, but evidence for the most suitable surgical treatments 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 expert-based, patient-specific practical recommendations on the appropriateness of surgical treatments for symptomatic knee articular cartilage lesions in competitive football players. The RAND/UCLA Appropriateness Method was used by 17 voting experts to provide recommendations on the suitability of six different surgical procedures (debridement, debridement+orthobiologics, bone marrow stimulation procedures, osteochondral autograft transplantation, allografts, and regenerative procedures) depending on four key clinical considerations: lesion location, defect size, bone involvement, and patient preference towards higher priority for a quick return to play or long-term results. These resulted in 96 scenarios (16 clinical scenarios for six surgical procedures). Altogether, in 94% of clinical scenarios, at least one surgical procedure was considered appropriate. Patient preference had the highest influence on the results. Debridement plus orthobiologics was most often considered appropriate in patients preferring a quick return to play, while regenerative techniques were more often considered appropriate with patients prioritising long-term results. Osteochondral autograft transplantation and allografts were considered appropriate only in selected scenarios, whereas bone marrow stimulation procedures were considered inappropriate or uncertain. The recommendations established by this ICRS-FIFA-Aspetar consensus on the appropriateness of different surgical procedures to treat symptomatic articular cartilage lesions in competitive football players should be used as broad guidelines, but the preferred treatment should be player-specific.