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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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess 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.

Methods

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).

Results

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).

Conclusions

Serious degenerative changes were found in a high number of retired female football players’ knees 10 years after their career. Meniscal integrity is key for knee osteoarthritis outcomes in young adults, and thus, its preservation should be a priority.

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Acknowledgements

The authors highly appreciate the cooperation of all participating players who volunteered their time to provide the data for this project. They especially thank Birgit Prinz without whom this study would not have been possible. The authors gratefully acknowledge the Fédération Internationale de Football Association (FIFA) for funding this project.

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Authors and Affiliations

  1. Department of Prevention, Health Promotion and Sports Medicine, Medical School Hamburg (MSH), Am Kaiserkai 1, 20457, Hamburg, Germany

    Annika Prien & Astrid Junge

  2. Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Annika Prien & Evert Verhagen

  3. Division of Radiology, University Hospital of Geneva, Geneva, Switzerland

    Sana Boudabous & Bénédicte M. A. Delattre

  4. Schulthess Clinic, Zurich, Switzerland

    Astrid Junge

  5. Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa

    Evert Verhagen

  6. Department of Orthopaedic Surgery and Traumatology, University Hospital of Geneva, Geneva, Switzerland

    Philippe M. Tscholl

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  1. Annika Prien
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  2. Sana Boudabous
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  3. Astrid Junge
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Corresponding author

Correspondence to Annika Prien.

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Conflict of interest

Annika Prien, Sana Boudabou, Astrid Junge, Evert Verhagen, Bénédicte M. A. Delattre and Philippe M. Tscholl declare that they have no conflict of interest.

Funding

The study was funded by the Fédération Internationale de Football Association (FIFA).

Ethical approval

The study has ethic approval 2016-449-f-S of the ethics commission Münster, Germany.

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Prien, A., Boudabous, S., Junge, A. et al. 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 Surg Sports Traumatol Arthrosc 28, 353–362 (2020). https://doi.org/10.1007/s00167-019-05560-w

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