Abstract：
OBJECTIVE: To systematically review the literature and analyze clinical outcomes and return-to-sport after surgical management of cartilage injuries in football players.
METHODS: A systematic literature review was performed in August 2023 on PubMed, WebOfScience, and Cochrane Library to collect studies on surgical strategies for cartilage lesions in football players. Methodological quality and risk of bias were assessed with the modified Coleman Methodology score and RoB2 and RoBANS2 tools.
RESULTS: Fifteen studies on 409 football players (86% men, 14% women) were included: nine prospective and two retrospective case series, one randomized controlled trial, one prospective comparative study, one case report, and one survey. Bone marrow stimulation (BMS) techniques were the most documented. The lesion size influenced the treatment choice: debridement was used for small lesions (1.1 cm2), BMS, osteochondral autograft transplantation (OAT), matrix-assisted autologous chondrocytes transplantation (MACT), and scaffold-augmented BMS for small/mid-size lesions (2.2-3.0 cm2), and autologous chondrocytes implantation (ACI) for larger lesions (5.8 cm2). The surgical options yielded different results in terms of clinical outcome and return-to-sport, with fastest recovery for debridement and scaffold-augmented BMS. The current evidence is limited with large methodological quality variation (modified Coleman Methodology score 43.5/100) and a high risk of bias.
CONCLUSIONS: Decision-making in cartilage injuries seems to privilege early return-to-sport, making debridement and microfractures the most used techniques. The lesion size influences the treatment choice. However, the current evidence is limited. Further studies are needed to confirm these findings and establish a case-based approach to treat cartilage injuries in football players based on the specific patient and lesion characteristics and the treatments\' potential in terms of both return-to-sport and long-term results.
METHODS: Systematic review, level IV.
METHODS: A systematic literature review was performed in August 2023 on PubMed, WebOfScience, and Cochrane Library to collect studies on surgical strategies for cartilage lesions in football players. Methodological quality and risk of bias were assessed with the modified Coleman Methodology score and RoB2 and RoBANS2 tools.
RESULTS: Fifteen studies on 409 football players (86% men, 14% women) were included: nine prospective and two retrospective case series, one randomized controlled trial, one prospective comparative study, one case report, and one survey. Bone marrow stimulation (BMS) techniques were the most documented. The lesion size influenced the treatment choice: debridement was used for small lesions (1.1 cm2), BMS, osteochondral autograft transplantation (OAT), matrix-assisted autologous chondrocytes transplantation (MACT), and scaffold-augmented BMS for small/mid-size lesions (2.2-3.0 cm2), and autologous chondrocytes implantation (ACI) for larger lesions (5.8 cm2). The surgical options yielded different results in terms of clinical outcome and return-to-sport, with fastest recovery for debridement and scaffold-augmented BMS. The current evidence is limited with large methodological quality variation (modified Coleman Methodology score 43.5/100) and a high risk of bias.
CONCLUSIONS: Decision-making in cartilage injuries seems to privilege early return-to-sport, making debridement and microfractures the most used techniques. The lesion size influences the treatment choice. However, the current evidence is limited. Further studies are needed to confirm these findings and establish a case-based approach to treat cartilage injuries in football players based on the specific patient and lesion characteristics and the treatments\' potential in terms of both return-to-sport and long-term results.
METHODS: Systematic review, level IV.
摘要：
目的：系统回顾文献，分析足球运动员软骨损伤手术治疗后的临床结果和恢复运动。
方法：2023年8月在PubMed上进行了系统的文献综述，WebOfScience,和Cochrane图书馆收集有关足球运动员软骨损伤手术策略的研究。使用改良的Coleman方法论评分以及RoB2和RoBANS2工具评估方法学质量和偏倚风险。
结果：15项研究涉及409名足球运动员（86％为男性，14%的女性)包括在内：9个前瞻性病例系列和2个回顾性病例系列，一项随机对照试验，一项前瞻性比较研究，一例病例报告,和一项调查。骨髓刺激（BMS）技术是记录最多的。病灶大小影响治疗选择：清创术用于小病灶（1.1cm2），BMS,自体骨软骨移植（OAT），基质辅助自体软骨细胞移植(MACT),小型/中型损伤（2.2-3.0cm2）和支架增强的BMS，和自体软骨细胞植入（ACI）用于较大的病变（5.8cm2）。手术选择在临床结果和重返运动方面产生了不同的结果，最快的清创和支架增强的BMS恢复。目前的证据有限，方法学质量差异较大（修改后的Coleman方法学评分43.5/100），偏倚风险较高。
结论：软骨损伤的决策似乎有利于早期恢复运动，使清创术和微裂缝成为最常用的技术。病变大小影响治疗选择。然而,目前的证据是有限的。需要进一步的研究来证实这些发现，并根据特定的患者和病变特征以及在重返运动和长期结果方面的治疗潜力，建立一种基于病例的方法来治疗足球运动员的软骨损伤。
方法：系统评价，四级。
方法：2023年8月在PubMed上进行了系统的文献综述，WebOfScience,和Cochrane图书馆收集有关足球运动员软骨损伤手术策略的研究。使用改良的Coleman方法论评分以及RoB2和RoBANS2工具评估方法学质量和偏倚风险。
结果：15项研究涉及409名足球运动员（86％为男性，14%的女性)包括在内：9个前瞻性病例系列和2个回顾性病例系列，一项随机对照试验，一项前瞻性比较研究，一例病例报告,和一项调查。骨髓刺激（BMS）技术是记录最多的。病灶大小影响治疗选择：清创术用于小病灶（1.1cm2），BMS,自体骨软骨移植（OAT），基质辅助自体软骨细胞移植(MACT),小型/中型损伤（2.2-3.0cm2）和支架增强的BMS，和自体软骨细胞植入（ACI）用于较大的病变（5.8cm2）。手术选择在临床结果和重返运动方面产生了不同的结果，最快的清创和支架增强的BMS恢复。目前的证据有限，方法学质量差异较大（修改后的Coleman方法学评分43.5/100），偏倚风险较高。
结论：软骨损伤的决策似乎有利于早期恢复运动，使清创术和微裂缝成为最常用的技术。病变大小影响治疗选择。然而,目前的证据是有限的。需要进一步的研究来证实这些发现，并根据特定的患者和病变特征以及在重返运动和长期结果方面的治疗潜力，建立一种基于病例的方法来治疗足球运动员的软骨损伤。
方法：系统评价，四级。
