When Is Surgery the Right Choice for Knee Cartilage Injuries in Footballers?

Knee cartilage injuries can be career-defining for football players. While surgery is often considered the obvious solution, recent research suggests it may not always be the most appropriate first step.

A global consensus developed by experts from ICRS, FIFA and Aspetar has helped clarify this issue. Among the contributors was Sydney Orthopaedic Research Institute’s Dr David Parker, who played a key role in shaping the study’s findings.

Published in the British Journal of Sports Medicine, this consensus paper explores when surgery should be considered for cartilage injuries in footballers and outlines the key factors that should guide clinical decision-making.

The Study: Evaluating 96 Real-World Scenarios

To reach consensus, researchers used the RAND/UCLA Appropriateness Method, a structured process that blends scientific evidence with expert opinion. Ninety-six clinical scenarios were assessed, each representing common presentations in footballers with cartilage injuries.

The scenarios considered:

• The size and location of the cartilage lesion

• The player’s symptoms and functional limitations

• The level of competition and performance expectations

• The player’s age and long-term goals

Experts then rated whether surgery was appropriate, uncertain or inappropriate in each situation.

Key Findings

• Surgery was considered appropriate in just 32% of cases. Despite the demands of elite-level football, non-surgical management was often favoured.

• Decisions were driven by symptoms and the player’s goals. Pain, instability and performance impact were more influential than imaging findings alone.

• Larger cartilage lesions were more likely to lead to surgery But lesion size wasn’t the only determining factor, many cases were deemed manageable without an operation.

  
  

Why This Matters for Players  and Clinicians

These findings emphasise the importance of individualised care. Cartilage injuries aren’t one-size-fits-all, and surgery is not always the answer, particularly when players are still functioning well or aiming to avoid long rehabilitation periods.

For clinicians, this consensus offers a valuable framework for making shared decisions with their patients. For players, it reinforces that the best outcomes often come from tailored care plans that consider more than just imaging or severity.

Where to Learn More

You can read the full consensus paper, along with other recent publications from SORI, at: www.sori.org.au/our-research/publications