Knee osteoarthritis is associated with previous meniscus and anterior cruciate ligament surgery among elite college American football athletes.
Smith MV, Nepple JJ, Wright RW, Matava MJ, and Brophy RH. Sports Health. 2016. [Epub Ahead of Print].https://www.ncbi.nlm.nih.gov/pubmed/27940573
Take Home Message: One in 4 American Football players at the NFL Combine with a history of knee surgery have knee osteoarthritis despite being only 20 to 26 years of age.
A football player is at high risk for a knee injury, which may have long-term implications (for example, osteoarthritis). Knee osteoarthritis is particularly concerning because it can be a chronic and disabling disorder. Unfortunately, we know very little about osteoarthritis among young elite American football players. Therefore, Smith and colleagues completed a retrospective cohort study to assess the relationship between previous knee injury, body mass index and player position on knee osteoarthritis. The authors reviewed records from 594 players (704 knees, 20 to 26 years of age) who attended the NFL Combine between 2005 and 2009. These players needed magnetic resonance (MR) imaging because of a history of knee injury/surgery or knee symptoms. This group was ~36% of all players attending the NFL Combine during this 5-year period. The authors defined osteoarthritis as moderate or severe nonfocal articular cartilage loss on MR images or joint space narrowing on x-ray. Overall, 423 of 704 included knees had a history of surgery. Osteoarthritis was present in 104 of the 704 (~15%) knees. A player with history of surgery was more likely to have osteoarthritis than someone without a history of surgery (23% versus 4%). The frequency of osteoarthritis was particularly high for those with a history of a partial meniscectomy (27%) or an anterior cruciate ligament reconstruction (24%), but less so for those with a history of a meniscal repair (11%). Player body mass index was associated with knee osteoarthritis but player position was not related to osteoarthritis.
The current study presents the next step in better understanding the development of long-term consequences in the knee following athletic participation with a history of knee surgery. It is important to note that all the players had a history of knee injury/surgery or had knee symptoms. This means that we are unable to determine the prevalence of knee osteoarthritis among all the players at the NFL Combine. Regardless, this study highlights that a player with a history of knee surgery is more likely to have knee osteoarthritis even though they are only 20 to 26 years of age. While the presence of structural changes is no guarantee that the player currently has knee symptoms it does increase the chances that they have or will develop knee symptoms. This could have a dramatic effect on an athlete’s playing career and quality of life after football. The current study was limited because the authors did not assess the severity of knee symptoms. Understanding the severity of knee symptoms would help clinicians identify what, if any impact a history of surgery may have on athletic performance, daily function, and quality of life. Furthermore, there was little detail provided to understand how these athletes were treated; such as, type of graft, type of rehabilitation following surgery, and return to play criteria. These are all factors that could affect the development of knee osteoarthritis. Despite these limitations, the current findings should inform clinicians that they need to be aware that these athletes are at increased risk for osteoarthritis, equitably council their athletes on the long-term consequences of injury/surgery, and seek to implement best clinical practices to prevent joint damage.
Questions for Discussion: What other factors would you be interested in future research evaluating in this population? Do you think these findings are generalizable to other populations?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Osteoarthritis Action Alliance’s Consensus Opinion for Best Practice Features of Lower Limb Injury Prevention Programs
Osteoarthritis Research Society International (OARSI) Guidelines for the Non-Surgical Management of Knee OsteoarthritisACL Injury May Increase the Likelihood of Knee Osteoarthritis