Sports Medicine Research: In the Lab & In the Field: Sports Med Res’ 1000th Post – Where are We Going? Football or Soccer…No Matter How You Say It, Former Professional Athletes Have Long-Term Knee Problems (Sports Med Res)


Wednesday, December 6, 2017

Sports Med Res’ 1000th Post – Where are We Going? Football or Soccer…No Matter How You Say It, Former Professional Athletes Have Long-Term Knee Problems

Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general populations: a cross-sectional study

Fernandes GS, Parekh SM, Moses J, Fuller C, Scammell B, Batt ME, Zhang W, & Doherty M. Br J Sports Med. 2017; Online Ahead of Print November 3, 2017.  

Take Home Message: Elite level soccer participation is associated with a two-fold increase in knee pain, radiographic changes, and knee replacement.
Soccer (or football everywhere other than the United States J) is a popular sport, which requires high-intensity activity, physical fitness, and has a relatively high knee injury risk.  After an athlete suffers an injury – they often return to their sport, and may be exposed to repetitive overloading on the previously injured joint, which ultimately leaves them susceptible to osteoarthritis.  These researchers conducted a cross-sectional study to compare ~1200 former professional soccer athletes to ~4000 males from the general population in the United Kingdom to see if previous participation in professional soccer was associated with increased knee pain, radiographic knee osteoarthritis, and total knee replacement surgery.  Researchers mailed nearly 45000 questionnaires to males over 40 years of age who either competed professionally in soccer or who were not terminally ill and participated in the Knee Pain in the Community Study within the National Health Service.  Overall, ex-soccer players had higher rates of knee pain, osteoarthritis, and total knee replacements compared with males in the general population.  Former soccer players were 2 times more likely to have knee pain, a little over 3 times as likely to report being diagnosed with osteoarthritis and almost 3 times more likely to report a total knee replacement than a typical male. Researchers completed bilateral knee x-rays on about 1000 males to assess radiographic outcomes.  Former soccer athletes were about 2 times more likely to have radiographic knee osteoarthritis than males in the general population, even after accounting for body mass index, age, and previous knee injury history.  

Sports Med Res was founded to help bridge the gap between research and clinical practice related to sports medicine. In our 1000th post we once again see evidence that some of our athletes are at high risk for poor long-term outcomes. Specifically, the authors found that former professional soccer athletes were at 2 times greater risk of reporting knee pain, knee osteoarthritis and total knee replacement surgery.  It was interesting that this higher risk still existed after controlling for other risk factors such as previous knee injury, as well as body mass index, and age.  While a knee injury is a known risk factor for osteoarthritis and chronic knee pain, the repetitive microtrauma on a joint may play a role in increased long-term complications.  It remains unclear if these former professional athletes are at an elevated risk because of the age they started competition, the duration of their career, how they managed their injuries (e.g., playing through pain or returning to play too soon), or some other factor inherent to the movements involved in soccer. This study reinforces previousfindings of elite level athlete reporting musculoskeletal complications years after competition.  This is more evidence adding to our growing knowledge that some athletes, particularly those with a joint injury or who compete at an elite level in certain sports, are at greater risk of long-term complications.  This represents a critical moment for researchers and clinicians to come together to preserve our patients’ long-term health and wellness. We need to come together to discuss how we can educate our patients about their risks, how they can reduce their chances of a poor outcome, and enable them to make an informed decision about continuing to compete.  We also need to determine if there are steps that we can put into place to reduce this risk; whether it involves changes in training, addition of rest days, or modification of load – there needs to be a point where we are not ok accepting that poor outcomes are inevitable for some athletes. 

Questions for Discussion:  Are you currently using any patient reported outcomes in athletes or after knee injury?  Are there any strategies that you use to try to educate athletes about long-term health? How can we fill the gap between research and clinical practice.

Written by: Nicole Cattano & Jeffrey Driban
Reviewed by: Stephen Thomas

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