A Critical Review of the Literature by:
Dr. Eduard Alentorn-Geli, Department of Orthopaedic Surgery, UniversitatAutonoma de Barcelona, Barcelona, Spain; Professor Brian J Cole Rush University Medical Center, Department of Orthopaedics, Chicago, United States of America; Professor Ramon Cugat Federation Espanola de Futbol. Mutua Montanesa, Barcelona, Spain
Abstract: Sports are generally considered a healthy and recommended activity. However, there is some concern regarding the mid-and long-term consequences of sports participation on articular cartilage. The purpose of this book chapter is to provide a comprehensive and critical review of the existing literature regarding studies investigating the relationship between sports and the risk of knee osteoarthritis.
This review demonstrates that despite some evidence that sports increases the risk of knee osteoarthritis, many studies have not controlled for some of the other important risk factors for this joint disorder. Therefore, it cannot be strongly concluded that sports alone increases the risk of degenerative joint disease about the knee when other risk factors are controlled in the analysis. Sports can generally be recommended to all patients, but special care must be taken in those with associated risk factors (overweight, previous knee injury, high occupational workload, among others).
Review of Evidence: There are many studies investigating the effects of sports participation on the development of knee osteoarthritis. Most of the existing evidence was published between 1990 and 2010 and largely consists of level III evidence studies. This section has been divided into sections based on the sports involved. Some studies have investigated the effects of several sports on the risk of knee osteoarthritis. These studies have been categorized in a separate section, although in some of them specific information for certain sports has been reported: Running, Soccer, Track and Field, Australian Football.
Conclusions: There are several studies with insufficient control of potential associated risk factors for osteoarthritis (age, gender, body mass index, occupational workload, and previous knee injuries). There is insufficient evidence to assure that sports increase the risk of knee osteoarthritis when other associated risk factors are absent. Thus, sports participation may not be considered an independent risk factor, but, instead, would increase the risk of osteoarthritis if accompanied by other risk factors. The presence of a combination of risk factors multiples the risk of osteoarthritis.
Subjects at greater risk of knee osteoarthritis may be overweight women with prior joint injury who wish to participate in sports with high impact and torsional loads and nonprofessional athletes engaged in similar activities who have a history of prior joint injury who additionally have physically demanding jobs. Based on the existing literature, sports cessation to prevent the development of knee osteoarthritis cannot be generally recommended. Instead, adequate preventative programs for osteoarthritis can be implemented toward weight loss, neuromuscular training (reduce the risk of knee injuries), occupational modifications, and regular exercise for health-related purposes.