Systematic Review
Prevalence of Articular Cartilage Lesions and Surgical Clinical Outcomes in Football (Soccer) Players’ Knees: A Systematic Review

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Purpose

To systematize the available scientific literature on the prevalence of articular cartilage and/or osteochondral lesions in football (soccer) players' knees, and overview the surgical procedures and functional outcomes and return to sports.

Methods

A comprehensive search using Pubmed, Cochrane Library, SPORTDiscus, and CINAHL databases was carried out until September 30, 2015. All English language studies that assessed the outcomes of a surgical technique for the treatment of articular cartilage lesions in football players' knees, with a minimum follow-up of 12 months, were included. The reference list of the most relevant papers was screened. The main outcomes of interest were the clinical, arthroscopy or imaging primary outcomes and the return to sports rate. The methodological and reporting qualities were assessed according to Coleman methodology score.

Results

The search provided 485 titles and abstracts. Five studies were eligible for inclusion (mean Coleman score of 37.2 points), comprising a total of 183 football players with a mean age of 25.7 years. A total of 217 articular cartilage and/or osteochondral lesions were reported, where the medial and lateral femoral condyles were the most common sites of lesion. The surgical procedures investigated were mosaicplasty, microfracture, autologous chondrocyte implantation, and chondral debridement.

Conclusions

No definitive conclusion could be made in respect to the best current surgical technique for articular cartilage and osteochondral lesions. Microfracture and mosaicplasty can provide a faster return to competition and faster clinical and functional results, whereas autologous chondrocyte implantation and/or matrix-induced autologous chondrocytes implantation procedures can enhance longstanding clinical and functional results.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

Section snippets

Search Strategy

The systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, which aims to improve the standard of reporting of systematic reviews and meta-analyses.39 The protocol used was a priori registered at the International Prospective Register of Systematic Reviews (PROSPERO) (http://www.crd.york.ac.uk/prospero/; ID: CRD42015025620).

A comprehensive database search using Pubmed, Cochrane Library, SPORTDiscus, and

Study Selection

The database and hand search resulted in 485 titles and abstracts. After duplicate removal, 370 papers were filtered, resulting in 16 full-text papers that were screened for eligibility. After the full-text screening, 5 original studies7, 8, 13, 33, 45 were eligible for inclusion and further analysis. Search strategy steps can be seen in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart (Fig 1), and the reasons for exclusion were as follows: case study,46, 47

Discussion

The main findings of our systematic review were that all surgical techniques showed good to excellent results in the most players, according to the Brittberg,7, 33 International Knee Documentation Committee,45 and the ICRS13 scoring systems. Furthermore, the football players could successfully return to sports after a microfracture,8, 45 mosaicplasty,13 ACI,45 or chondral debridement.7 These results are encouraging because, when dealing with professional football players, returning as fast and

Conclusions

This study showed that no definitive conclusion could be made in respect to the best surgical technique for articular cartilage and osteochondral lesions. Microfracture and mosaicplasty can provide a faster return to competition and faster clinical and functional results, whereas ACI and/or MACI procedures can enhance longstanding clinical and functional results.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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