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



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.


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).


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).


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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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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Correspondence to Annika Prien.

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


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

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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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  • Football (soccer)
  • Osteoarthritis
  • Knee injury
  • Long-term outcomes
  • Meniscus
  • Female athlete