Lower limb clinical and radiographic osteoarthritis in former elite male athletes

Former Olympians had remained on high bone mineral density for a long period: Consecutive checkup of the 1964 Tokyo Olympic Japanese contestants for over 50 years

INTRODUCTION

We performed consecutive checkups of the 1964 Tokyo Olympic contestants every 4 years for 50 years. This study evaluated bone mineral density (BMD) and its related factors in former Tokyo Olympic athletes.

OBJECTIVES

The study population comprised 181 former Olympians (141 men and 40 women) who had undergone BMD measurement in at least one of the four checkups performed every 4 years since 2005. The mean age of the 104 subjects who participated in the last checkup in 2016 was 76.1 years for men and 74.0 years for women.

METHODS

Health-related information regarding medical history, regular physical activity, alcohol consumption, and smoking was obtained using questionnaires. The areal BMD of the total body was measured using dual-energy X-ray absorptiometry (DXA). The relationship between BMD and anthropometric measurements, medical history, and health behaviors was examined. Furthermore, we assessed the influence of the mode and magnitude of weight-bearing and impact loading during athletic events during their active careers on BMD.

RESULTS

The mean Z-scores of BMD of the total body, lumbar spine, pelvis, and upper and lower limbs were > 0 in both male and female subjects at each checkup. The subjects had a higher mean height and weight than the Japanese age- and sex-matched individuals. Furthermore, the subjects had higher grip strength than the age- and sex-matched individuals. BMD showed a positive correlation with body weight, lean body mass (LBM), muscle mass, and grip strength, with higher correlation coefficients found between BMD of the pelvis or lower limbs and LBM or muscle mass volume. When the association with current participation in sports activities was examined, male subjects who exercised weekly had significantly higher grip strength and greater muscle mass volume; however, no significant differences were observed among female subjects. After adjusting for age and LMB, BMD was significantly higher in both the lumbar spine and lower limbs of male subjects with relatively more impact loading in sports events during their active careers.

CONCLUSION

The Tokyo Olympic contestants maintained a high muscle mass even at an older age, regardless of their medical history, which may be one of the reasons for their ability to maintain a high BMD.

Prevalence and risk factors of ankle osteoarthritis in a population-based study

BACKGROUND

This study aimed to investigate the prevalence of radiographic ankle osteoarthritis (AOA) in Japan and identify its risk factors.

METHODS

The analysis included data from the population-based cohort study, radiographs of the knees and ankles, ultrasonography of the ankle to examine chronic ankle instability (CAI), and questionnaires on ankle pain, job history, height, and body weight. A total of 597 individuals aged > 50 years were included in the study. The risk factors for AOA were calculated using multivariate logistic regression analysis.

RESULTS

The study revealed a 13.9% prevalence of radiographic AOA among the participants, with 1.2% reporting painful AOA. Female sex, aging, history of ankle fractures, and CAI were identified as the risk factors associated with AOA.

CONCLUSIONS

This cross-sectional study highlights the significant prevalence of radiographic AOA in a rural Japanese population, emphasizing the importance of considering ankle fractures and CAI as potential risk factors for AOA development.

LEVELS OF EVIDENCE

Level II, prospective cohort study.

Sport-specific Differences in Cartilage Treatment

Articular cartilage defects in the knee are common in athletes who have a variety of loading demands across the knee. Athletes of different sports may have different baseline risk of injury. The most studied sports in terms of prevalence and treatment of cartilage injuries include soccer (football), American football, and basketball. At this time, the authors do not specifically treat patients by their sport; however, return to sports timing may be earlier in sports with fewer demands on the knee based on the rehabilitation protocol. If conservative management is unsuccessful, the authors typically perform a staging arthroscopy with chondroplasty, followed by osteochondral allograft transplantation with possible additional concomitant procedures, such as osteotomies or meniscal transplants. Athletes in a variety of sports and at high levels of competition can successfully return to sports with the appropriate considerations and treatment.

Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits

Background

Rates of cartilage degeneration in asymptomatic elite basketball players are significantly higher compared with the general population due to excessive loads on the knee. Compositional quantitative magnetic resonance imaging (qMRI) techniques can identify local biochemical changes of macromolecules observed in cartilage degeneration.

Purpose/Hypothesis

The purpose of this study was to utilize multiparametric qMRI to (1) quantify how T1ρ and T2 relaxation times differ based on the presence of anatomic abnormalities and (2) correlate T1ρ and T2 with self-reported functional deficits. It was hypothesized that prolonged relaxation times will be associated with knees with MRI-graded abnormalities and knees belonging to basketball players with greater self-reported functional deficits.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

A total of 75 knees from National Collegiate Athletic Association Division I basketball players (40 female, 35 male) were included in this multicenter study. All players completed the Knee injury and Osteoarthritis Outcome Score (KOOS) and had bilateral knee MRI scans taken. T1ρ and T2 were calculated on a voxel-by-voxel basis. The cartilage surfaces were segmented into 6 compartments: lateral femoral condyle, lateral tibia, medial femoral condyle, medial tibia (MT), patella (PAT), and trochlea (TRO). Lesions from the MRI scans were graded for imaging abnormalities, and statistical parametric mapping was performed to study cross-sectional differences based on MRI scan grading of anatomic knee abnormalities. Pearson partial correlations between relaxation times and KOOS subscore values were computed, obtaining r value statistical parametric mappings and P value clusters.

Results

Knees without patellar tendinosis displayed significantly higher T1ρ in the PAT compared with those with patellar tendinosis (average percentage difference, 10.4%; P = .02). Significant prolongation of T1ρ was observed in the MT, TRO, and PAT of knees without compared with those with quadriceps tendinosis (average percentage difference, 12.7%, 13.3%, and 13.4%, respectively; P ≤ .05). A weak correlation was found between the KOOS-Symptoms subscale values and T1ρ/T2.

Conclusion

Certain tissues that bear the brunt of impact developed tendinosis but spared cartilage degeneration. Whereas participants reported minimal functional deficits, their high-impact activities resulted in structural damage that may lead to osteoarthritis after their collegiate careers.

The influence of different sports on cartilage adaptations: A systematic review

Molecular composition and structural adaptation are changes in the cartilage tissue after different stimuli. Sports activities with different loads at different angles, speeds, and intensities can modify the molecular composition of the articular cartilage, hence it is crucial to understand the molecular adaptations and structural modifications generated by sports practice and this review aims to synthesize the current evidence on this topic. A systematic search until July 2022 was performed on the database Medline, Pubmed, Scopus, and Web of Science with a collection of 62,198. After the screening process, the included articles were analyzed narratively. Thirty-one studies have been included in the analysis. From the results emerged that running, swimming, ballet and handball were not correlated with detrimental structural or molecular cartilage adaptation; instead, soccer, volleyball, basketball, weightlifting, climbing, and rowing showed signs of cartilage alteration and molecular adaptation that could be early predictive degeneration's signs. From the included studies it came to light that the regions more interested in morphological cartilage changes were the knee in athletes from different disciplines. In conclusion, different sports induce different cartilage modifications both at a molecular and structural level and it is important to know the risks correlated to sports to implement preventive strategies.

Osteoarthritis Risks and Sports: An Evidence-based Systematic Review

PURPOSE

Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA.

METHODS

A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 .

CONCLUSION

Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.

Elderly Runners and Osteoarthritis: A Systematic Review

PURPOSE

The impact of running on the onset of osteoarthritis (OA) is controversial. This study compared the incidence of OA in elderly runners versus nonrunners.

MATERIAL AND METHODS

This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in January 2022. All the published clinical studies investigating OA onset in runners versus non-runners were considered. Studies reporting data on OA and participants in other sports were excluded. Only studies investigating patients with a mean age older than 55 years were considered. The methodological quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS).

RESULTS

Data from 3001 participants and 6674 joints were retrieved. The mean age was 59.4±2.7 years. The mean body mass index was 24.6±2.5 kg/m2. The 5 included articles (963 runners, 2038 nonrunners) did not report significant differences in runners compared with controls.

CONCLUSION

Middle aged runners did not present greater imaging or clinical signs of OA compared with nonrunner controls. Running at elite or recreational level did not increase the rate of OA progression in individuals older than 50 years.

Intensive Physical Activity Increases the Risk of Knee and Hip Arthroplasty: A Systematic Review

PURPOSE

The present study investigated the type of sport and activity level of athletes before they underwent knee and/or hip arthroplasty for osteoarthritis (OA), and compared them with a control group of subjects who did not undergo knee and hip arthroplasty. We hypothesed athletes exposed to high physical loads during sports had the highest risk of developing OA requiring arthroplasty.

MATERIALS AND METHODS

This systematic review was conducted according to the PRISMA guidelines. All the comparative clinical trials to August 2021 investigating the sport activity level between subjects who underwent arthroplasty versus those who did not undergo arthroplasty for OA were considered.

RESULTS

Data from 5 studies and 3638 patients were collected. The mean age for both groups was 47.61±15.5 years, and the mean body mass index was 24.6±2.1 kg/m2 17.6% were women. The Newcastle-Ottawa scale attested good quality of the methodology of the investigations included in the present study.

CONCLUSION

Intense physical exercise, implying a high cumulative number of hours of exercise which can lead to excessive joint overload, in both sexes is associated with greater likelihood of early knee and hip OA which may lead to prosthetic surgery. Moderate and recreational exposure to sport has minor degenerative effects, and is not associated with early onset OA requiring arthroplasty.

Osteoarthritis in Athletes Versus Nonathletes: A Systematic Review

INTRODUCTION

Joint overload and sport-related injuries may accelerate the development of osteoarthritis (OA). A systematic review of the literature was performed to establish the risk of athletes to develop premature OA compared with nonathletes.

MATERIALS AND METHODS

This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in June 2021. All the published clinical studies investigating OA onset in athletes versus nonathletes were considered. Studies reporting data on secondary and/or post-traumatic OA were excluded.

RESULTS

Data from 32 articles (20,288 patients) were retrieved. The mean age was 67.8±10.0 years and the mean body mass index was 25.0±2.5 kg/m2. 74% (6859 patients) of the athletes suffered from premature OA. Of them, 21% were active in soccer, 11% in handball, 11% in ice-hockey, 3% in football, and 0.3% in rugby. 26% of the athletes reported no significant differences in OA progression compared with healthy controls. Of these athletes, 47% were runners, 5% dancers, and 1% triathletes.

CONCLUSION

Certain sports, such as soccer, handball, ice-hockey, and rugby are more likely to be associated with premature knee and hip OA. Conversely, runners and ballet dancers do not evidence significant increase in OA. Moderate and recreational exposure to aerobic sports does not accelerate the development of OA.

Health conditions among retired professional footballers: a scoping review

Objective

To conduct a scoping review providing an overview of the health conditions occuring in retired male and female professional footballers, with an emphasis on musculoskeletal, mental, neurocognitive, cardiovascular and reproductive health conditions.

Methods

In January 2022, a comprehensive systematic literature search in three databases (MEDLINE via PubMed, SPORTDiscus via EBSCOhost and EMBASE) was conducted for common health conditions among retired male and female professional footballers. Primary research studies (full text available online) which described the incidence or prevalence of a health condition (musculoskeletal, mental, neurocognitive, cardiovascular, reproductive) among retired male and female professional footballers were included for review. Case reports, qualitative research and grey literature were omitted.

Results

In total, 917 eligible articles were identified from the databases, with 41 meeting the eligibility criteria. Osteoarthritis of the hip, knee and ankle were found to be common among retired professional footballers. Mental health symptoms (eg, anxiety, depression) are experienced by retired male and female professional footballers. The incidence of neurocognitive disease appears to be higher among retired male professional footballers than among matched controls. There is very limited evidence examining the presence of health conditions in retired female professional footballers.

Conclusion

Osteoarthritis of the lower limb, musculoskeletal pain and mental health symptoms are common among retired professional footballers. Knowledge about the occurrence and timing of musculoskeletal, mental health and neurocognitive conditions among retired professional footballers can be used by a wide range of stakeholders to proactively intervene during and after a player's career to mitigate risk.

Multiparametric MRI characterization of knee articular cartilage and subchondral bone shape in collegiate basketball players

Magnetic resonance imaging (MRI) is commonly used to evaluate the morphology of the knee in athletes with high-knee impact; however, complex repeated loading of the joint can lead to biochemical and structural degeneration that occurs before visible morphological changes. In this study, we utilized multiparametric quantitative MRI to compare morphology and composition of articular cartilage and subchondral bone shape between young athletes with high-knee impact (basketball players; n = 40) and non-knee impact (swimmers; n = 25). We implemented voxel-based relaxometry to register all cases to a single reference space and performed a localized compositional analysis of T 1ρ - and T 2 -relaxation times on a voxel-by-voxel basis. Additionally, statistical shape modeling was employed to extract differences in subchondral bone shape between the two groups. Evaluation of cartilage composition demonstrated a significant prolongation of relaxation times in the medial femoral and tibial compartments and in the posterolateral femur of basketball players in comparison to relaxation times in the same cartilage compartments of swimmers. The compositional analysis also showed depth-dependent differences with prolongation of the superficial layer in basketball players. For subchondral bone shape, three total modes were found to be significantly different between groups and related to the relative sizes of the tibial plateaus, intercondylar eminences, and the curvature and concavity of the patellar lateral facet. In summary, this study identified several characteristics associated with a high-knee impact which may expand our understanding of local degenerative patterns in this population.

Clinical Hip Osteoarthritis in Current and Former Professional Footballers and Its Effect on Hip Function and Quality of Life

The objective of the study was to establish the prevalence of clinical hip osteoarthritis in current and former professional footballers and to explore its consequences on hip function and health-related quality of life (HRQoL). A cross-sectional study by means of questionnaire was conducted among current and former professional footballers fulfilling the following inclusion criteria: (1) male (2) active or retired professional footballer (3) member of FIFPRO (Football Players Worldwide) (4) between 18 and 50 years old (5) could read and understand texts in French, Spanish, or English. Controls (matched for: gender, age, body weight and height) were also recruited. The main outcome measures were clinical hip osteoarthritis, hip function and HRQoL. Questionnaires were sent to 2,500 members of which 1,401 participated (1,000 current and 401 former professional footballers). Fifty-two controls were recruited. Prevalence of hip osteoarthritis was 2% among current and 8% among former professional footballers. Hip function was significantly (p ≤ 0.001) lower in both types of footballers with hip osteoarthritis than in footballers without hip osteoarthritis and controls. Current and former professional footballers with hip osteoarthritis reported significantly lower physical health scores (p = 0.032, p = 0.002) than those without. Hip osteoarthritis led to a significantly lower score in the physical (p = 0.004) and mental (p = 0.014) component of HRQoL in former footballers compared to the controls, while in current footballers only the physical component was significantly (p = 0.012) lower compared to the controls. Hip osteoarthritis has a higher prevalence in former than in current professional footballers and impacts hip function and HRQoL negatively.

The Risk of Knee Osteoarthritis in Professional Soccer Players—a Systematic Review With Meta-Analyses

BACKGROUND

We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis.

METHODS

A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria.

RESULTS

The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%).

CONCLUSION

A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.

Football-related injuries are the major reason for the career end of professional male football players

PURPOSE

Little is known about the consequences of injuries on professional male football players' career and retirement period. The aim of this study is to investigate the impact of injuries that male professional football players endure during their career, reasons for the end of their career and the post-career phase of retirement.

METHODS

In a retrospective cross-sectional cohort study, retired male professional football players of the German Bundesliga were investigated by a standardised questionnaire to analyse the history of injuries sustained during their professional football career, the reasons for ending their career, their current health status and their suggestions for future prevention strategies.

RESULTS

Most of the 116 analysed players (n = 73 (62.9%)) stated an injury as the reason for ending their professional career. Relevant injuries were mainly located in the lower extremities (n = 587 (61.3%)) with a focus on the knee (p < 0.001) and ankle (p < 0.001). A significant majority of the participants who had retired due to injury described degenerative symptoms, such as pain or instability, and were diagnosed with osteoarthritis after retirement (p < 0.001). These players had also often been affected by symptoms of depression during their career, which had decreased significantly after retirement. Moreover, players who had not retired due to injury had significantly better overall health status and quality of life after retirement.

CONCLUSION

Football-related injuries have a significant impact on the career end of professional male football players and their health status after retirement. Future prevention strategies need to particularly address injuries to the knees and ankles and to implement measures for preventing osteoarthritis after retirement.

LEVEL OF EVIDENCE

Level III.

Every second retired elite female football player has MRI evidence of knee osteoarthritis before age 50 years: a cross-sectional study of clinical and MRI outcomes

PURPOSE

To assess knee health in retired female football players, using magnetic resonance imaging (MRI) and self-report. The focus of analysis were degenerative changes of the tibiofemoral joint, and their relationship to osteoarthritis symptoms and previous knee injury.

METHODS

Forty-nine retired elite, female football players (98 knees) aged 37 years on average participated. Tibiofemoral cartilage and meniscus status of both knees were evaluated using MRI and graded according to modified Outerbridge and Stoller classifications, respectively. Symptoms were assessed through a standardised questionnaire (Knee Osteoarthritis Outcome Score: KOOS). Knee injury history was recorded via a semi-structured interview. To investigate how injury variables relate to outcomes, binary logistic regression models were used and reported with odds ratios (OR).

RESULTS

Fifty-one per cent of players (n = 25) fulfilled the MRI criterion for knee osteoarthritis, 69.4% (n = 34) had substantial meniscal loss and 59.6% (n = 28) reported substantial clinical symptoms. Chondral- and meniscal loss were associated with significantly lower scores on three of five KOOS subscales (p < .05). Both chondral and meniscal loss were significantly predicted by previous traumatic knee injury (OR = 4.6, OR = 2.6), the injury affecting the non-striking leg (OR = 8.6, OR = 10.6) and type of injury; participants with combined ACL/meniscus injuries had the highest risk for substantial chondral and meniscal loss (OR = 14.8, OR = 9.5). Chondral loss was significantly predicted by isolated meniscus injury treated with partial meniscectomy (OR = 5.4), but not by isolated reconstructed ACL injury. Clinical symptoms were only significantly predicted by previous traumatic knee injury (OR = 5.1).

CONCLUSIONS

Serious degenerative changes were found in a high number of retired female football players' knees 10 years after their career. Meniscal integrity is key for knee osteoarthritis outcomes in young adults, and thus, its preservation should be a priority.

One-staged combined hip and knee arthroplasty: retrospective comparative study at mid-term follow-up

Background

To date, few knowledge is available about safety and effectiveness of one-staged combined hip and knee arthroplasty. The aim of our study was to evaluate, in a comparative fashion, complications and outcomes in patients who underwent one-staged hip and knee arthroplasty.

Methods

Forty-two patients were enrolled and allocated into two groups of 21 patients each: one-staged hip and knee arthroplasty (group A) and two-staged hip and knee arthroplasty (group B). The follow-up averaged 50.2 months. Postoperative complications and implant survivorship were assessed prospectively. Outcomes were evaluated with Harris Hip score (HSS), Western Ontario Mc-Ministry score for the hip (h-WOMAC), Knee Society score (KSS), and Western Ontario Mc-Ministry knee score (k-WOMAC). Hip and knee range of motion (ROM) were measured both preoperatively and at the last follow-up.

Results

Two (9.5%) patients in group A and three (14.3%) patients in group B developed complications (P = 0.8). Although a significant decrease in postoperative haemoglobin (Hgb) values was found in group A patients during the hospital stay, no differences in blood transfusions were found (P = 0.8). No significant differences were found comparing clinical-functional outcomes between the two groups, while a significant reduction of hospital length of stay was shown in group A patients.

Conclusions

One-staged combined hip and knee arthroplasty could be considered in patients with co-existing severe hip and knee osteoarthritis, providing similar complications and mid-term outcomes of two-staged procedures. However, the reproducibility safety and reliability of these procedures should be confirmed in prospective comparative randomised trials with more numerous patients.

Trial registration

Retrospectively registered

Prevalence of knee osteoarthritis in former athletes: a systematic review with meta-analysis

BACKGROUND

Prevalence of knee osteoarthritis in former athletes is still unclear.

OBJECTIVE

To investigate prevalence of knee osteoarthritis in former athletes. Moreover, the secondary aim was to investigate whether poor methodological quality of included studies, different diagnosis criteria for knee osteoarthritis, different sports modality or sex impact on overall estimated prevalence of knee osteoarthritis in former athletes.

METHODS

Searches on MEDLINE, EMBASE, AMED, SPORTDiscus and CINAHL from the earliest record to February 2018 and hand-searching identified studies investigating prevalence of knee osteoarthritis in former athletes. Meta-analysis was conducted and the GRADE system summarized strength of the current recommendations. Sensitivity analyses investigated whether methodological quality, diagnostic criteria, type of sports or sex impacted on the overall estimated prevalence in former athletes. This review was registered at PROSPERO (CRD42016050903).

RESULTS

Fifteen studies were included and pooling of 3100 participants estimated overall prevalence of knee osteoarthritis in former athletes of 30.0% (95% CI: 20.0 to 40.0%). The strength of the current recommendations was low-quality. Sensitivity analyses suggested that different diagnostic criteria for knee osteoarthritis and type of sports may impact on the overall estimated prevalence.

CONCLUSIONS

Prevalence of knee osteoarthritis in former athletes was 30.0%. Researchers, clinicians and policymakers should be careful about potential prevalence differences among type of sports and diagnostic criteria. Current low-quality evidence shows that future high-quality studies are likely to impact on the estimated prevalence.

Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study

OBJECTIVES

To identify by systematic review published prevalence estimates of radiographic ankle osteoarthritis (OA) and to subsequently estimate the prevalence of ankle pain and symptomatic, radiographic ankle OA within community-dwelling older adults from North Staffordshire, UK.

METHODS

Electronic databases were searched using terms for ankle, osteoarthritis and radiography. Data regarding population, radiographic methods, definitions and prevalence estimates of ankle OA were extracted from papers meeting predetermined selection criteria. Adults aged ≥50 years and registered with four general practices in North Staffordshire were mailed a health questionnaire. Ankle pain in the previous month was determined using a foot and ankle pain manikin. Respondents reporting pain in or around the foot in the last 12 months were invited to attend a research clinic where weight-bearing, antero-posterior and lateral ankle radiographs were obtained and scored for OA using a standardised atlas. Prevalence estimates for ankle pain and symptomatic, radiographic ankle OA were calculated using multiple imputation and weighted logistic regression, and stratified by age, gender and socioeconomic status.

RESULTS

Eighteen studies were included in the systematic review. The methods of radiographic classification of ankle OA were poorly reported and showed heterogeneity. No true general population prevalence estimates of radiographic ankle OA were found, estimates in select sporting and medical community-dwelling populations ranged from 0.0-97.1%. 5109 participants responded to the health survey questionnaire (adjusted response 56%). Radiographs were obtained in 557 participants. The prevalence of ankle pain was 11.7% (10.8,12.6) and symptomatic, radiographic ankle OA grade≥2 was 3.4% (2.3, 4.5) (grade≥1: 8.8% (7.9,9.8); grade = 3: 1.9% (1.0,2.7). Prevalence was higher in females, younger adults (50-64 years) and those with routine/manual occupations.

CONCLUSION

No general population prevalence estimates of radiographic ankle OA were identified in the published literature. Our prevalence study found that ankle pain was common in community-dwelling older adults, whereas moderate to severe symptomatic, radiographic ankle OA occurred less frequently. Further investigations of the prevalence of ankle OA using more sensitive imaging modalities are warranted.

Osteoarthritis of the hip and knee in former male professional soccer players

BACKGROUND

Professional soccer (PS) players are at great risk of osteoarthritis (OA) of the knee and hip.

SOURCES OF DATA

Following the PRISMA guidelines, the key words 'osteoarthritis' and 'soccer' or 'football' were matched with 'players' or 'former' or 'retired' and with 'hip' or 'knee' on December 24, 2017 in the following databases: PubMed, Cochrane, Google scholar, Embase and Ovid. Only comparative studies reporting the prevalence rate of OA of both hip and knee joint in former PS athletes (fPSa) and age and sex matched controls were considered.

AREAS OF AGREEMENT

In fPSa, the prevalence rate of OA of both hip and knee is significantly higher compared to age and sex matched controls.

AREAS OF CONTROVERSY

The pathological pathways responsible for the development of OA of the hip and knee in PS athletes (PSa) are still not clearly understood.

GROWING POINTS

The prevalence rate of clinical OA of the hip was 8.6% in fPSa and 5.6% in controls (odd ratio (OR) = 1.5; 95% CI: 1.06-2.31). The radiographic rate of OA was 21.2% in fPSa and 9.8% in controls (OR = 2.4; 95% CI: 1.66-3.69). A total of 14.6 and 53.7% of fPSa presented clinical and radiographic signs of OA of the knee, respectively, vs 12.9% (OR = 1.16; 95% CI: 0.86-1.55) and 31.9% (OR = 2.47; 95% CI: 2.03-3.00) of controls. Sonographic evidence of OA of the knee was found in 52% of fPSa and 33% of controls (OR = 2.2; 95% CI: 1.24-3.89).

AREAS TIMELY FOR DEVELOPING RESEARCH

Preventive training programmes should be developed to reduce the number of fPSa presenting early OA.

Osteoarthritis and joint replacements of the lower limb and spine in ex-professional soccer players: A systematic review

After a professional career as a soccer player, the risk of developing osteoarthritis (OA) in different joints of the spine and lower limb might be increased. The extent of this problem to date is not clear. Therefore, the aim of this systematic review is to summarize the prevalence of OA and joint replacement of the lower limb and spine in former professional soccer players. Relevant databases were searched with different combinations of key words: for example, OA, hip, knee, ankle, foot, joint replacement, soccer. Studies were included if they were original research, included a sample of former professional male soccer players, and had OA in the lower limb and/or spine; OA was diagnosed either through questionnaires or X-rays; and the article is in English, Dutch, or German. Sixteen studies with 1576 former players and 2153 control subjects were included in the review. Studies agreed that the prevalence of hip OA and hip replacements is significantly higher in former players compared to the control group. For the ankle and spine, there is only limited information, and for the prevalence of knee OA and knee replacement, the results are contradictory. The quality of the included studies was moderate. Future studies should have a prospective design to control for confounding factors, to identify possible risk factors and consequences for the individuals, and to be able to develop a prevention program.

Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes

PURPOSE

The primary aim was to establish the association between osteoarthritis (OA) and the occurrence and comorbidity of symptoms of common mental disorders (CMD: distress, anxiety/depression, sleep disturbance, adverse alcohol use) in a group of former elite athletes (rugby, football, ice hockey, Gaelic sports and cricket). A secondary aim was to explore this association in the subgroups of sports.

METHODS

Cross-sectional analysis was performed on the baseline questionnaires from five prospective cohort studies conducted between April 2014 and January 2016 in former elite athletes of rugby, football, ice hockey, Gaelic sports and cricket. The presence of OA (diagnosed by a medical professional) was examined with a single question, and symptoms of CMD were evaluated through multiple validated questionnaires (4DSQ, GHQ-12, PROMIS, AUDIT-C).

RESULTS

There was a significant association between OA and symptoms of distress (OR 1.7, 95 % CI 1.2-2.6), sleep disturbance (OR 1.6, 95 % CI 1.1-2.3), adverse alcohol use (OR 1.8, 95 % CI 1.2-2.6) and a comorbidity of symptoms of CMD (OR 1.5, 95 % CI 1.0-2.1) in former elite athletes.

CONCLUSION

OA might be a risk factor for developing symptoms of CMD in former elite athletes. The clinical relevance of this study is that an interdisciplinary approach to the clinical care and support of former elite athletes after their careers is advocated as the interaction between the physical and mental health issues occurring on the long term is complex. Monitoring OA among former elite athletes should be empowered while strategies to prevent symptoms worsening should be developed and implemented. The self-awareness, prevention and care of mental health problems that might occur after a professional sports career should also be addressed.

LEVEL OF EVIDENCE

Level III.

Prevalence of Knee Osteoarthritis in 100 Athletically Active Veteran Soccer Players Compared With a Matched Group of 100 Military Personnel

BACKGROUND

Although knee injuries in professional soccer (football) have been extensively studied, the prevalence of knee osteoarthritis (OA) in veteran players is not well documented.

PURPOSE

To investigate the prevalence of knee OA in retired professional soccer players in comparison with a group of athletically active military personnel.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A group of 100 veteran Greek soccer players aged 35 to 55 years (mean [±SD] age, 46.90 ± 5.9 years) were examined for knee OA and were administered the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A matched group of 100 athletically active military personnel served as a comparison group.

RESULTS

The sonographic prevalence of OA was significantly higher in the veteran soccer group (52%) than in the military group (33%) (n = 200; P = .010). This difference remained significant even after excluding participants with a history of knee surgery (44.1% vs 25.3%, respectively) (n = 151; P = .010). Femoral cartilage thickness was similar between the 2 groups (P = .473), while altered knee alignment had no effect on the prevalence of OA (P = .740). With the exception of perceived pain being more prevalent in the military group, there were no other statistically significant differences between the 2 groups in KOOS values.

CONCLUSION

Veteran soccer players had a higher sonographic prevalence of knee OA but better pain scores than a matched group of athletically active military personnel.

Osteoarthritis and the Tactical Athlete: A Systematic Review

OBJECTIVE

 Although tactical athletes (eg, military service members, law enforcement personnel, fire fighters) are exposed to several known risk factors, it remains unclear if they are at increased risk for osteoarthritis (OA). The purpose of this systematic review was to investigate the association between serving as a tactical athlete and the incidence and prevalence of OA.

DATA SOURCES

 We completed a comprehensive systematic literature search in November 2014 using 12 bibliographic databases (eg, PubMed, Ovid, SportDiscus) supplemented with manual searches of reference lists.

STUDY SELECTION

 Studies were included if they met the following criteria: (1) an aim of the study was to investigate an association between tactical athletes and OA; (2) the outcome measure was radiographic OA, clinical OA, total joint replacement, self-reported diagnosis of OA, or placement on a waiting list for a total joint replacement; (3) the study design was a cohort study; and (4) the study was written in English.

DATA EXTRACTION

 One investigator extracted data from articles that met all inclusion criteria (eg, group descriptions, measures of disease burden, source of nonexposed controls).

DATA SYNTHESIS

 Twelve articles met the inclusion criteria and described retrospective cohort studies. Firefighters, active-duty military service members, and veteran military parachutists consistently had a higher incidence or prevalence of knee, hip, or any OA diagnosis (4 studies). Active-duty pilots and veteran military parachutists may have a higher prevalence of spine OA, but this was not statistically significant (2 studies). Occupational risk factors for OA among tactical athletes include rank and branch of military service. The risk of OA among individuals who completed mandatory national military service remains unclear (6 studies).

CONCLUSIONS

 The incidence of OA among tactical athletes appears to be significantly higher when compared with nonexposed controls. Further research is needed to specifically identify modifiable risk factors within this high-risk population to develop and implement effective risk-reduction strategies.