Sports Medicine Research: In the Lab & In the Field: The Meniscus is Key to Long-Term Joint Health (Sports Med Res)


Wednesday, September 6, 2017

The Meniscus is Key to Long-Term Joint Health

The Long Term Impact of Osteoarthritis Following Knee Surgery in Former Collegiate Athletes

Simon JE, Grooms DR, and Docherty CL. J Sports Rehab. 2017. [Epub Ahead of Print].

Take Home Message: Many former college athletes with a history of knee surgery, especially for meniscal pathology, reported a diagnosis of osteoarthritis. Those with a history of surgery and diagnosis of osteoarthritis reported poorer long-term outcomes than their peers.

Joint injury – and subsequent surgery – have a major impact on an athlete’s quality of life and increases the risk for an early onset of osteoarthritis. Unfortunately, we know very little about the state of our patients’ quality of life 15 to 25 years after surgery. Therefore, Simon and colleagues completed a cross-sectional study to identify the long-term consequences of knee surgery in a cohort of former collegiate athletes. A total of 100 (60 males, 40 females) former Division 1 athletes between 40 and 65 years of age completed questionnaires to collect demographics, past injury history (including any previous diagnosis of osteoarthritis), knee-related symptoms (KOOS), and overall quality of life (SF-36v2). Overall, 77% of athletes with a history of knee surgery reported being diagnosed with knee osteoarthritis. A significant majority of participants who developed knee osteoarthritis after having a surgery, reported combination injuries (ligamentous and meniscal; 55%) or meniscal injuries (27%). Conversely, participants who reported a previous knee surgery but no diagnosis of osteoarthritis reported that their injuries were primarily ligamentous only. On average, the individuals with a history of knee surgery and diagnosis of knee osteoarthritis had worse physical quality of life worse and knee-related pain, symptoms, quality of life, and function. The adults with a history of knee surgery but not osteoarthritis had similar quality of life and knee-related outcomes as adults with no history of knee surgery.

Overall, many people with a history of knee surgery, especially for meniscal pathology, reported a diagnosis of osteoarthritis. This subset of adults with a history of knee surgery and diagnosis of osteoarthritis also typically reported poorer long-term outcomes (e.g., lower quality of life, poorer physical function). It is important to consider that these adults typically had surgery 19 to 40 years ago when partial or total meniscectomies were more commonly performed than today. Previous literature has demonstrated that preserving a meniscus is likely key to protecting the long-term health of a joint. Thus, when meniscal injuries are diagnosed clinicians should encourage their patients to seek interventions to restore/preserve the protective properties of the meniscus.  Given the timing of this assessment, we can’t rule out that some former athletes incorrectly reported their history of knee surgery or diagnosis of osteoarthritis. This study offers compelling evidence that we need to begin monitoring our athletes over time to see how quality of life changes as they age. In the meantime, this study offers further evidence that we need to encourage the use of injury prevention programs to help reduce the number of athletes who need knee surgery. It remains remarkable that injury prevention programs, which can dramatically reduce the risk of injury and surgery and probably the long-term consequences of these events remains underutilized in sports.  

Questions for Discussion: Do you talk to patients after knee surgery about how to preserve their quality of life and physical function?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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