Abstract
To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers. This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders. Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs. Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire. Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs). Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes. This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.
Highlights
Osteoarthritis (OA) is a common complex disorder[1] with multiple risk factors, including age, body mass index (BMI), previous injury, and occupation.[2]
The odds increased to almost 13 times greater for knee pain (KP) [adjusted odds ratio (aOR), 12.97; 95% confidence interval (CI), 7.92-21.26] and total knee replacement (TKR) [aOR, 12.57; 95% CI, 6.39-27.76] and 5 times greater for radiographic KOA (RKOA) [aOR, 4.78; 95% CI, 2.42-9.46] in footballers who suffered at least 5 or more significant knee injuries
Following our recent comparative study, which demonstrated that retired professional footballers had a higher prevalence of knee OA (KOA) than general population controls,[12] this within-group case–control study identified that (1) knee injury is associated with KP, RKOA, and TKR; (2) there was a 7% increased odds for RKOA for every 1000 hours of training; and (3) age and gout are another 2 risk factors associated with all 3 KOA outcomes
Summary
Osteoarthritis (OA) is a common complex disorder[1] with multiple risk factors, including age, body mass index (BMI), previous injury, and occupation.[2] A meta-analysis in 2011 has previously demonstrated a strong association between a history of knee injuries and subsequent knee OA (KOA) in the general population.[3]. A recent study comparing retired professional male footballers with general population controls demonstrated an increased prevalence of knee pain (KP), radiographic KOA www.cjsportmed.com. Clin J Sport Med (RKOA), radiographic knee chondrocalcinosis (CC), and total knee replacement (TKR) in footballers.[12] The aim of this study was to examine, within retired professional footballers, potential risk factors that may account for the increased prevalence of KP, RKOA, and TKR
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