Purpose: Rugby union (rugby) is a full contact collision sport with global participation of over 7.23 million men, women and children across 120 countries. Osteoarthritis (OA) is a leading cause of pain and chronic disability globally, more commonly diagnosed in older populations. There is a known association between injury and the development of OA; however the relationship between sport, exercise and injury remains ill-defined. As participation in rugby continues to rise and sport, exercise and physical activity are promoted, it is important to understand whether there is an association between sporting exposure and joint loading attributable to sports participation, and any subsequent development of negative musculoskeletal outcomes of the lower limb. The aim of this study was to describe the prevalence of OA within a cohort or former elite International rugby players, and examine which potentially modifiable rugby-related and injury-related risk factors are most predictive of OA-related outcomes. Methods: A cross-sectional questionnaire was sent to former English International rugby players. Both postal and online recruitment strategies were used. Players received an initial overview describing the study’s aims and objectives before its launch, a formal approach to participate following its launch, and reminder communications. Former players reported their playing history, injury history, family history of OA, current pain, sentiments on their rugby career and the sport, and an abbreviated medical history. GP-diagnosed wear and tear, degeneration or OA and joint replacement were reported per person and by joint. Rugby-specific risk factors of total playing duration, duration at International level and total number of matches were tested for association with the primary outcome of any OA (physician diagnosed or joint replacement) at any joint; and the secondary outcome of site-specific OA at the knee or hip. Injury-specific risk factors of any rugby injury, and any joint-specific rugby injury were assessed for association with any OA and lower limb joint-specific OA. Univariable logistic regression was used to assess the association of each predictor with the primary and secondary outcomes. Results: 138 participants responded to this questionnaire. Participant demographics (mean (SD)) are: Age, 62 (15.5); Height 1.8 (0.1) m; Weight, 94.8 (16.2) kg; BMI, 28.9 (3.5) kg/m2. The prevalence of any GP-diagnosed OA was 61.5% and any joint replacement was 27.0%. GP-diagnosed OA at the hip was reported by 19.6% of respondents, with 16.9% reporting hip replacement. GP-diagnosed OA at the knee was reported by 38.5% of players, with 12.2% reporting knee replacement. The majority of players reflected positively on their playing career, with 90.5% of players stating that they would do the same again. Most players would recommend the sport to their relatives (74.3%) and 90.5% of players felt that rugby had enriched their lives. The mean (SD) playing load values are: total years rugby, 32.7 (4.5); number of seasons at International level, 3.8 (2.6); number of matches, 437.7 (185.5). The vast majority of players reported having had a severe injury, defined as 4 weeks or more of reduced participation in exercise, training or sport (86.7%). Severe injury of the knee was more prevalent (38.5%) than for the hip (20.3%). In this unadjusted univariable logistic regression of rugby-related predictors, no association was found between rugby playing load and OA outcomes at any or specific joints (Table 1 - * denotes significance). Rugby-related injury was found to be associated with GP-diagnosed OA, and associations were found between joint-specific rugby injury and OA of the hip (GP-diagnosed and joint replacement) and knee (GP-diagnosed). Conclusions: This study has described the prevalence of OA-outcomes in this population, and demonstrates a higher prevalence of hip and knee OA than many other population-based studies which range from 5.4 to 14.3 for symptomatic radiographic OA of the knee and 0.7–5.5 for symptomatic radiographic OA of the hip. The association of rugby injury (any, knee and hip) with OA reaffirms data previously published, suggesting an increased risk of the development of OA following joint injury. This study has shown that rugby playing load is not predictive of negative OA-outcomes in later life, at the knee and hip. The strong association of rugby injury with OA-outcomes at the knee and hip reinforces that injury is the most significant modifiable-risk factor of these predictors.Table 1The association between rugby and injury-specific risk factors and OA-outcomesPredictorAny GP OAAny TJRGP: HipTJR: HipGP: KneeTJR: KneeInjuryOR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)Any1.93 (.71–5.22)0.73 (.25–2.11)2.25 (.49–10.40)1.09 (.29–4.08)1.84 (.62–5.49)0.64 (.17–2.50)Any rugby injury2.57 (1.11–5.94)*0.73 (.30–1.79)0.87 (.32–2.39)0.69 (.25–1.93)2.14 (.85–4.43)0.56 (.18–1.72)Joint-specific rugby injury––4.88 (1.99–11.92)*6.75 (2.65–17.24)*7.15 (3.04–16.78)*1.73 (.58–5.15)RugbyTotal years of play0.96 (.88–1.03)0.97 (.89–1.06)0.97 (.87–1.07)0.97 (.87–1.08)0.97 (.91–1.07)1.03 (.92–1.15)Years at highest level1.03 (.90–1.17)0.99 (.86–1.14)0.99 (.85–1.16)0.95 (.80–1.13)1.01 (.90–1.16)0.96 (.79–1.16)Number of games0.99 (.99–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00) Open table in a new tab
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Open Access
Jun 18, 2023
Haad Arif + 4
