This a academic report, maybe very boring for you, have fun and enjoy!

less invasive strategies are available that have varying degrees of impact depending on the stratification of degen- erative chondropenia or osteoarthritis (Figure 4). These suggestions can permit an active lifestyle and have, given the prevalence of the disease, a public health impact as a quality of life enhancement.

Due to the significant impact of articular cartilage injury and degeneration for the player, the ultimate goal for FIFA and the ICRS is a prevention paradigm: prevention of the injury, whether acute or overuse, and prevention of chon- dropenia and osteoarthritis and the progression over time. Injury prevention has been a major focus of FIFA and F-MARC through development of the Prevent Injury and Enhance Performance (PEP) program and the evolution to the FIFA 11+ program. The PEP program was designed to reduce ACL injuries, and several studies including a level I randomized control trial have documented significant reductions when this program is successfully utilized as a warm up.22 The evolution to the FIFA 11+ program now includes focus on not only the knee but also muscle, groin, and ankle injury. Significant reductions in severe, overuse, and knee injuries have been demonstrated in large con- trolled trials.23 Therefore, injury reduction is not only pos- sible, but it also can and should be a reality and part of any football program. These programs are time efficient, easy to do, and are free of expense!

The natural course progression is that articular cartilage defects are to become osteoarthritis over time. The next step in the FIFA/ICRS initiative is how to prevent this progres- sion. Drs. Zaslav, McAdams, Scopp, Theosadakis, Mahajan, and Gobbi evaluate new frontiers for cartilage repair and protection.24 Although recent treatments for damage to articular cartilage have been successful in alleviating symp- toms, more durable and complete, long-term articular sur- face restoration remains the unattained. This hopeful and futuristic approach looks at both new ways to prevent dam- age to articular surfaces as well as new techniques to re-create biomechanically sound and biochemically true articular surfaces once an athlete injures this surface. This “holy grail” objective should be to produce hyaline carti- lage with a well-integrated and flexible subchondral base and the normal zonal variability. Newer surgical techniques, some already in clinical study, and others on the horizon offer opportunities to improve the surgical restoration of the hyaline matrix often disrupted in athletic injury. These include new scaffolds, single-stage cell techniques, engi- neered allogeneic tissues, the use of mesenchymal stem cells, and gene therapies.

The last step of the prevention paradigm is to prevent the progression of osteoarthritis severity over time. There are a number of nonoperative interventions that have shown early promise in mitigating cartilage symptoms and in pre- clinical studies have shown evidence for potential disease modification, chondrofacilitation, and chondroprotection. These include the use of glucosamine, chondroitin, and other neutraceuticals, viscosupplementation with hyal- uronic acid, platelet-rich plasma, and pulsed electromag- netic fields.

In summary, this supplement provides a compact refer- ence for players, coaches, medical staff, and researchers working with football (soccer) players. It intends to act as a catalyst for the advancement of science and education of cartilage injury in football and the development of innova- tive treatment concepts and prevention strategies that help to further reduce the incidence of cartilage injury and risk of osteoarthritis in football players of all ages and skill levels. The approach to the athlete always uses the “spectrum of care” systematic paradigm: prevention, performance, injury care, rehabilitation, restoration and return to sport, preven- tion of reinjury and osteoarthritis, and keeping the aging athlete healthy through exercise. The main objective of the FIFA and ICRS collaboration is to identify the scope of these problems and develop multidisciplinary solutions with the major goal of prevention for now and the future. Also FIFA / F-MARC took the initiative and sponcored a Professorship “Cartilage Engeneering” at the Swiss Federal Institute of Technology (ETH ZH) to stimulate the basic research which again could contribute to prevention and and maybe as a vision to regenerate cartilage damadge in vivo to shorten the time of rehabilitation and “return to play”. It was Einstein who said, “It is the intelligent that can solve prob- lems but the genius will prevent them.” It is with this spirit that we thank FIFA and its president, Mr. Joseph S. Blatter, the ICRS and its president, Professor Daniel Saris, and all the authors for their timely and impactful contributions, all of which make the game of football a better game! Play on!

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