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Articular cartilage injury is prevalent in football players and results from chronic joint stress or acute traumatic injuries. Articular cartilage injury can often result in progressive painful impairment of joint function and limit sports participation. Management of articular cartilage injury in athletes aims to return the player to competition, and requires effective and durable joint surface restoration that resembles normal hyaline articular cartilage that can withstand the high joint stresses of football. Existing articular cartilage repair techniques can return the athlete with articular cartilage injury to high-impact sports, but treatment does not produce normal articular cartilage, and this limits the success rate and durability of current cartilage repair in athletes. Novel scientific concepts and treatment techniques that apply modern tissue engineering technologies promise further advancement in the treatment of these challenging injuries in the high demand athletic population. We review the current knowledge of cartilage injury pathophysiology, epidemiology and aetiology, and outline existing management algorithms, developing treatment options and future strategies to manage articular cartilage injuries in football players.

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.

Objective While the approach to concussion and post-concussion syndrome management remains largely clinical, significant advancements have been made in identifying potential biomarkers to aid in the diagnosis and management of head injures. One such potential biomarker is Brain Network Activation (BNA) analysis. BNA is a multi-channel, EEG-ERP based platform that involves algorithmic analysis to provide a network map of cortical activity and quantitative data during specific tasks. Design Case Series. Setting Outpatient, clinic-based. Participants Three (3) athletes. Outcome measures Analysis of the subject’s BNA performance yieldsa BNA score,which reflects the degree of similarity between the performance of the subject and the normative data. BNA scores are further placed into one of three subcategories: Working Memory and Attention (Target Stimuli), Automatic Attention Orienting (Novel Stimuli), and Sensory (Frequent Stimuli). Each subject underwent a BNA analysis while symptomatic, followed by repeat analyses once subjects were identified as clinically asymptomatic. Main results In each of the three studies, there were improvements in BNA scores identified in one, or several, subcategories. More importantly, improvements in BNA scores directly correlated with clinical improvement in the post-concussive setting. Conclusions Approach to concussion management, in both the short-term and long-term setting, remains largely clinical. Current research seeks a more objective means of assessing not only potential structural abnormalities following a concussion, but also an improved means of assessing a patient’s neurocognitive status. BNA has proven to be an effective, supportive tool in allowing clinicians and patients to objectify one’s progress following a concussive injury. Competing interests None.

Background Knee injuries are prevalent in cutting, pivoting, and jumping sports. Studies have investigated the effects of exercise-based knee injury prevention programs, however no clinical practice guidelines (CPG) exist. Objective 1) Review the evidence for exercise-based knee injury prevention programs, 2) identify if there are exercise-based knee injury prevention programs that are effective for particular groups of athletes, 3) explore the evidence for dosage and delivery of exercise-based knee injury prevention programs, 4) provide information on how exercise-based knee injury prevention should be implemented. Design Systematic review for CPG development. Setting Multiple. Patients (or Participants) Healthy, active individuals, particularly athletes participating in cutting, pivoting, and jumping sports. Interventions (or Assessment of Risk Factors) A systematic review of literature was performed via PubMed, Scopus, SportDiscus, CINAHL, and the Cochrane databases for relevant articles addressing the effects of an exercise-based knee injury prevention program. The final search was performed in April, 2016 to identify all articles published prior to that point. Main Outcome Measurements The effects and outcomes of exercise-based knee injury prevention programs. Results Thirty-seven studies met the inclusion criteria for this CPG. Exercise-based knee injury prevention programs have a low implementation cost and large relative risk reductions. Clinicians should implement an exercise-based knee injury prevention program for all athletes involved in cutting and pivoting type sports to reduce the number of significant knee injuries. The program should be implemented two to three times per week in the preseason and one to three times per week in the competitive season. It should consist of a combination of plyometric training, strength and power exercises, balance and dynamic stabilization training, core strengthening, technique training, and/or sports-specific drills. Conclusions This CPG will provide evidence based guidance for clinicians in choosing and implementing exercise-based knee injury prevention programs appropriate for the athlete(s) they work with.

Objectives: The purpose of this study is to test the efficacy of a hamstring injury prevention program designed to address the high incidence of acute and chronic hamstring injuries and re-injuries that occur in the sport of professional baseball. Methods: This was a prospective cluster cohort study assessing the efficacy of an injury prevention intervention designed to address hamstring injury in rookie and professional baseball players participating in Minor and Major League Baseball (N = 213). Each athlete was asked to participate and consented (Johns Hopkins Internal Review Board, Baltimore, Maryland). Those athletes who agreed to participate completed a questionnaire detailing their hamstring injury history. The hamstring injury prevention program was disseminated to each medical staff (team physician, certified athletic trainer and strength and conditioning coach) and they were instructed on how to implement the program. Weekly individual compliance with the program and injury data was collected. At the end of the season, the data were analyzed for program compliance and hamstring (HS) injury rates (both acute and reoccurrence) compared to the control data in the MLB HITS database. All data were stripped of individual and team identifiers prior to analysis. Results: For the major and minor league intervention study, one Major and Minor League organization served as the intervention (INT) team, which encompassed Rookie League, Fall Ball, Class A, AA, AAA and major league rosters (6 total teams). A total of 213 athletes consented to participate: Minor League: N = 173 players and Majors League: N = 40. Weekly compliance, injury incidence and time loss due to injury was compared to the HITS database (age, skill matched control group). The average weighted utilization of the injury prevention program was 25.30 utilizations for the uninjured group compared to 13.53 in the injured group (p=0.09). In the majors, there were 2 HS injuries in the INT vs. 79 in the CON (IR: .025 INT vs .068 CON, p < 0.05); constituting a 25% reduction in HS injury. In the minors, there were 7 HS injuries in the INT vs. 297 in the CON (IR: .039 INT vs. .065 CON, p < 0.05), constituting a 40% reduction in the minor league HS injuries. There was a significant reduction in time loss due to injury for both the major and minor league INT players compared to the CON. For the Major League INT, there were 9 vs. 25.9 days lost in the CON group, resulting in a 65.3% reduction in time loss (pConclusion: The reduction in hamstring injury in the major and minor league intervention teams is consistent what researchers have reported with respect to the efficacy and value of utilizing a this intervention program in other sports. The intervention is a time and cost efficient means to reduce hamstring injury incidence and time loss in professional baseball players. This study is continuing in a prospective manner for an additional competitive season.

Background The efficacy of the FIFA 11+ program in collegiate soccer. Objective Can the FIFA 11+ effectively reduce injury in the competitive male soccer player?. Design Prospective randomized controlled trial conducted in the NCAA. Every institution (N=411) was contacted via a formal letter, email and phone call. Sixty-one institutions consented to participate. Human ethics approval was acquired through Quorum IRB, Seattle, WA, USA. The intervention group received an instructional DVD, manual and placards. A injury surveillance database was utilized (HealtheAthlete TM , Kansas) for data collection. Every exposure, injury, and compliance data was entered weekly. Setting NCAA institutions playing competitive soccer. Participants 61 institutions completed the study: 34 control (N=850 athletes) and 27 intervention (N=675 athletes). Intervention The FIFA 11+ injury prevention program served as the intervention program. It was utilized three times per week for the duration of the season. Main outcome measurements Specific injuries, athletic exposures, program compliance and time loss were recorded. Results In the intervention Group (IG), 285 injuries were reported (mean=10.56 injuries/team+/− 3.64) compared to 665 injuries (mean=20.15 +/− 11.01) in the control group (CG). The number of athletic exposures was 35,226 (Games: 10 935 AE, Practice: 24 291AE) for the IG and 44 212 (Games: 13 624 AE, Practice: 30 588 AE) in the CG). The incidence rate (IR) was 8.09/1000 AE (95% CI) in the IG compared to 15.04/1000 AE (95% CI) in the CG (P=.00117). Total days missed due to injury was 2 824 (mean=9.94) in the IG compared to 8776 days (mean=13.20) in the CG. Conclusions: The FIFA 11+ was shown to reduce injury rates and time loss in the male collegiate soccer player in a statistically significant manner.