Every second retired elite female football player has MRI evidence of knee osteoarthritis before the age of 50 years

This latest article to which we contributed, assessed 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.

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).

Relationship of MRI outcomes and self-reported KOA symptoms

Relationship of MRI outcomes and self-reported KOA symptoms

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).

Coronal (a) and sagittal (b) reconstructions of 3D T2 True-FISP sequence. Left knee of a 30-year-old player 9years after ACLrevision surgery with combined partial medial meniscectomy. a Bilateral meniscal extrusion of ≥ 2mm (double arrows) resulting in a meniscus score of 4 on both sides. a, b Chondral grade 4 lesion to the medial femur condyle and tibial plateau (thick arrows), resulting in a medial tibiofemoral cartilage score of 32. b Probable chronic postero-medial subluxation of the medial femur condyle.

Coronal (a) and sagittal (b) reconstructions of 3D T2 True-FISP sequence. Left knee of a 30-year-old player 9years after ACLrevision surgery with combined partial medial meniscectomy. a Bilateral meniscal extrusion of ≥ 2mm (double arrows) resulting in a meniscus score of 4 on both sides. a, b Chondral grade 4 lesion to the medial femur condyle and tibial plateau (thick arrows), resulting in a medial tibiofemoral cartilage score of 32. b Probable chronic postero-medial subluxation of the medial femur condyle.

Serious degenerative changes were found in a high number of former elite female football players knees as soon as 10years after their professional career with a significant impact on their QOL. The main clinical implications of our findings are:

(a) preserving meniscal function is key to improve long-term knee health, i.e. repair over removal;

(b) allowing sufficient recovery time is especially important for injuries affecting the weight bearing leg; and

(c) active female football players need to be further encouraged to include effective knee injury prevention programs in their training regime.

Annika Prien, Sana Boudabous, Astrid Junge, Evert Verhagen, Bénédicte Delattre. 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. Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-019-05560-w

The full article can be accessed here (paid access)