of knee pain, radiographic osteoarthritis and arthroplasty in retired
professional footballers compared with men in the general populations: a
cross-sectional study
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.
Nicole Cattano
& Jeffrey Driban
by: Stephen Thomas