In this series of blogs with a London 2012 Olympic flavour we have discussed the evidence on the main running related injuries, neuromuscular warm up strategies and tape for patellofemoral pain syndrome.  I’m going to London to watch the women’s Olympic football semi finals at Wembley Stadium this week. I hope that I will be watching Team GB and that they produce a winning performance!

In the matches so far some of the teams were very physical in their play. So far in the men’s football competition, 1st August, there have been on average per match 24.7 fouls, 3.9 yellow cards, and 0.1 red cards. In contrast in the women’s competition there have only been 18.9 fouls and 1.7 yellow cards on average per match. I was wondering what the long term effects of playing sport at this level may be when I came across a systematic review, from a Dutch team, investigating the prevalence of knee and/or ankle osteoarthritis in former elite soccer players.

Here’s what they did

The authors undertook a search of databases up to January 2012 for studies written in English, Dutch, French or German and included 4 studies. They used a modified version of the quality assessment criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist and the criteria created by Radulescu et al. for prevalence studies.

Here’s what they found

• Two studies, evaluated as having a high methodological quality, found a prevalence rate of knee osteoarthritis (OA) between 60 and 80%. Both studies used radiographic examination as their measurement instrument to diagnose OA; the presence of ankle OA was not determined.
• The other two studies, evaluated as having a moderate methodological quality, found a prevalence rate of knee OA between 40 and 46% and a prevalence rate of ankle OA between 12 and 17%. These studies used a questionnaire as their measurement instrument wherein players were asked if they had ever been diagnosed with OA by a medical specialist.

The author’s conclusions

The prevalence of knee and ankle OA in former elite soccer players can be considered high compared to the general population and to other occupations. To identify players at risk for OA, a health surveillance program should be implemented in elite soccer as a preventive measure.

The Musculoskeletal Elf’s thoughts

There was a large difference in prevalence of osteoarthritis between the studies. This difference could be explained by a differences in number of factors; the age of the populations, the amount of exposure to professional soccer (length of professional career), or the measurement instrument to determine OA (radiographic versus self report questionnaire). However it is well known that there is a weak association between radiographic findings, symptoms and functional ability. The later did not appear to have been measured in the primary studies. Three of the four studies did not give explicit information about the sex of participants and it is assumed that they were all male. The authors also restricted their search to studies in English, Dutch, French or German and only between 2000 and 2011 and thus additional data may have been available.

However it is clear that the prevalence of knee and/or ankle OA in former elite soccer players is high compared to the general population and to other occupations. I think I will stick to my social jogging and watch football from the sidelines! Go team GB.

Do you see former elite sportsmen and women with osteoarthritis of the knee or ankle or other musculoskeletal conditions? What is your view on this review do you have other information that may support or refute these findings. Will it change your clinical practice in terms of preventative measures? Send us your views on this blog and become part of the Musculoskeletal Elf community.

Links

• Kuijt MT, Inklaar H, Gouttebarge V, Frings-Dresen MH.Knee and ankle osteoarthritis in former elite soccer players: A systematic review of the recent literature. J Sci Med Sport. 2012 May 7. [Epub ahead of print] http://dx.doi.org/10.1016/j.jsams.2012.02.008
• The Musculoskeletal Elf. Running-related musculoskeletal injuries. [accessed July 2012]
• The Musculoskeletal Elf. Patellar taping for treating patellofemoral pain syndrome [accessed July 2012]
• The Musculoskeletal Elf. Neuromuscular warm-up strategies can reduce lower extremity injury incidence. [accessed July 2012]
• Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) http://www.strobe-statement.org/