Andrew Massey

This consensus statement represents an update to Mental Health in Elite Athletes: International Olympic Committee Consensus Statement (2019) . To advance a more standardised, evidence-based approach to mental health in elite athletes, an International Olympic Committee (IOC) Consensus Group critically evaluated the current science via a systematic literature review, sought consensus using Delphi methodology and provided recommendations relevant to this topic. Key themes include that mental health symptoms and disorders are (1) common among elite athletes; (2) may have sport-related aetiologies and manifestations; and (3) can impact performance. Routine screening for and monitoring of mental health symptoms and disorders in elite athletes using validated instruments is recommended. Management strategies should promote mental well-being in addition to preventing and treating mental health symptoms and disorders. These strategies should address all contributors to mental health symptoms, including factors within the environments in which athletes train and compete. Treatment may include psychotherapy, medication and other culturally or contextually appropriate modalities. With appropriate support and treatment, many athletes experiencing mental health symptoms and disorders can continue to train and compete safely, but sometimes modification of sport participation may be necessary. Elite athletes who are transitioning out of sport, elite Para athletes and elite young (adolescent) athletes are relatively understudied and may have distinct mental health concerns, in addition to those impacting elite athletes in general.

Participants in this priority-setting activity were 24 individuals who attended the second IOC consensus meeting on mental health in elite athletes. The demographic characteristics and professional roles of these individuals have been described elsewhere.5 Guided by prior applications of consensus methodology to priority setting,6–9 we employed a two-phase process …

In 2023, the International Olympic Committee (IOC) published its Mental Health Action Plan (MHAP), reaffirming that 'there is no health without mental health'.5 The plan called for proactive, system-wide strategies that embed mental health initiatives across sport governance, support-staff education and provision of timely care. This aligns with the IOC’s consensus statement on elite athlete mental health,2 which asserts that “a supportive ecosystem allows athletes with mental health symptoms or disorders to be proactively managed and to flourish.” As part of the MHAP, the IOC developed 10 organisational indicators to help sporting bodies assess and strengthen their approach to athlete mental health. These indicators (table 1, table 2) are not prescriptive standards but a pragmatic, evidence-informed framework intended to support self-assessment, benchmarking and staged organisational improvement. Notably, they shift responsibility from individual athletes to …

Knee articular cartilage lesions are frequent in football players, but evidence for the most suitable surgical treatments is lacking. The aim of this International Cartilage Regeneration & Joint Preservation Society, Fédération Internationale de Football Association and Aspetar (ICRS-FIFA-Aspetar) consensus was to develop expert-based, patient-specific practical recommendations on the appropriateness of surgical treatments for symptomatic knee articular cartilage lesions in competitive football players. The RAND/UCLA Appropriateness Method was used by 17 voting experts to provide recommendations on the suitability of six different surgical procedures (debridement, debridement+orthobiologics, bone marrow stimulation procedures, osteochondral autograft transplantation, allografts, and regenerative procedures) depending on four key clinical considerations: lesion location, defect size, bone involvement, and patient preference towards higher priority for a quick return to play or long-term results. These resulted in 96 scenarios (16 clinical scenarios for six surgical procedures). Altogether, in 94% of clinical scenarios, at least one surgical procedure was considered appropriate. Patient preference had the highest influence on the results. Debridement plus orthobiologics was most often considered appropriate in patients preferring a quick return to play, while regenerative techniques were more often considered appropriate with patients prioritising long-term results. Osteochondral autograft transplantation and allografts were considered appropriate only in selected scenarios, whereas bone marrow stimulation procedures were considered inappropriate or uncertain. The recommendations established by this ICRS-FIFA-Aspetar consensus on the appropriateness of different surgical procedures to treat symptomatic articular cartilage lesions in competitive football players should be used as broad guidelines, but the preferred treatment should be player-specific.

The ongoing and systematic collection, analysis, interpretation, and dissemination of information on player health and related factors for the purpose of informing health-related decision-making, (...

Objective To investigate global cardiac screening practices among elite male and female football players. Methods We surveyed all 211 FIFA Member Associations (MAs) between February and July 2024 using a 21-point questionnaire. Results A total of 165/211 (78%) MAs completed the survey. Cardiac screening was recommended or mandated by 81% (134/165) of responding MAs, with a variation between FIFA Confederations ranging from 33% (3/9 of MAs within the Oceania Football Confederation) to 100% (10/10 MAs within the South American Football Confederation). The majority of MAs use a protocol inclusive of at least medical history, physical examination and 12-lead ECG for adult male (123/134, 92%), adult female (119/134, 89%), youth male (112/134, 84%) and youth female (108/134, 81%) players. The inclusion of echocardiography was more common among adult male (91/134, 68%) and female (84/134, 63%) players compared with youth male (59/134, 44%) and youth female players (59/134, 44%). Among youth players, the age at initial cardiac screening (median age (IQR)=14 (4) years, range: 6–17 years) and the interval of serial screening were highly variable. Conclusion Routine cardiac screening is widely, but not uniformly, applied across football associations globally. There is considerable variation in cardiac screening practices based on geography and player age, suggesting that standardised global recommendations for cardiac screening in both adult and youth football are needed.

Event-related mental health problems among elite athletes are prevalent. However, empirical details on the development and implementation of a comprehensive mental health support programme at international sporting events are lacking. Therefore, this paper aims to provide consensus-driven, evidence-based recommendations to guide such a development and implementation. An 8-stage process based on the RAND-UCLA Appropriateness Method was adopted to collate and synthesise the available literature on this topic, to identify gaps in the scientific evidence and to enlist expert experience from a multidisciplinary expert panel to fill these gaps. Within such a process, the existing scientific literature was explored while experts (including athletes) were consulted to reach consensus on the recommendations. Accordingly, a robust pre-event plan is required to ensure the successful implementation of a comprehensive mental health programme during sport events, focussing on promotion, prevention, treatment and recovery. During sporting events, according to the defined pre-event plan, various activities targeting athletes, coaches, the entourage, officials or fans should be implemented: for example, educational programmes to decrease stigma, raise awareness and support help-seeking, a mental fitness area for decompression and relaxation, inperson mental health services provided by qualified mental health professionals with sport-specific as well as trauma-informed and violence-informed skills and mental health surveillance in parallel with the existing injury and illness surveillance programmes. Post event, a thorough evaluation of the implemented activities should be conducted while surveillance data should be analysed to identify areas requiring future targeted intervention(s). Also, particular attention should be given to postevent mental health support including the use of decompression interventions to support adjustment, emotional processing and reintegration.

Sudden cardiac death is the leading medical cause of death among football players. Determining the optimal cardiac screening, the use of carefully selected medical assessments to detect underlying cardiovascular conditions associated with sudden cardiac arrest/death, is a desired objective of the Fédération Internationale de Football Association (FIFA) for football players of all ages. To date, cardiac screening recommendations in football have primarily focused on adult competitive players. Acknowledging its responsibility for player health worldwide, FIFA convened an international working group of cardiology and sports medicine experts to develop cardiac screening recommendations for youth football players. This group performed structured literature reviews and ultimately congregated in January of 2024, when recommendations were presented, scrutinised and judged using a systematic process. The final FIFA recommendations for youth cardiac screening include personal medical history, family medical history, focused physical examination and resting 12-lead electrocardiography. This document provides detailed rationale and clinical recommendations for youth cardiac screening and emphasises the importance of emergency action planning.

Knee cartilage lesions are frequent in football players, but evidence for surgical treatment is lacking. The aim of this International Cartilage Regeneration & Joint Preservation Society, Fédération Internationale de Football Association, and Aspetar (ICRS-FIFA-Aspetar) consensus was to develop specific expert-based, patient-specific practical recommendations on the appropriateness of non-surgical or surgical treatments for symptomatic knee cartilage lesions in competitive football players. The RAND/UCLA appropriateness method was used, and 17 voting experts provided recommendations on the appropriateness of surgical treatment in 96 different clinical scenarios defined on 6 variables: cartilage injury onset, lesion location, defect size, bone involvement, player symptom level and preference towards higher priority of a quick return to play or long-term results. Surgical treatment of a cartilage lesion was considered appropriate in 32% of the scenarios, in 21% inappropriate, while in 47% of the scenarios, the appropriateness was considered uncertain. The parameters with the highest appropriateness for the surgical treatment of a cartilage lesion in a football player were the inability to play (75.0% of appropriate scenarios), a lesion sized 2 cm ² or bigger (47.9% of appropriate scenarios) and the preference of the player for long-term results (41.7% of appropriate scenarios). In this ICRS-FIFA-Aspetar expert consensus, surgical treatment for cartilage injuries in competitive football players was considered appropriate only in one-third of the clinical scenarios, and the choice was mainly driven by the level of symptoms. Surgical preference was also influenced by larger lesions, lesions of the condyles and trochlea with subchondral bone involvement and player’s preference towards long-term results.