Skip to main content

Sports Participation, Sports Injuries and Osteoarthritis

Implications for Prevention

Abstract

There is increasing concern that too much physical activity may lead to osteoarthritis. The continuous stress that physical activity places on the joints can result in microtrauma and degeneration of the articular cartilage. However, the onset of osteoarthritis appears to depend on the frequency, intensity and duration of physical activity. Research has shown that individuals of all ages can tolerate moderate amounts of exercise without adverse consequences or accelerated development of osteoarthritis. However, excessive participation in high impact sports, particularly over a long period of time and at an elite level, can increase the risk of developing osteoarthritis. Participants may also be at risk if they have abnormal joint anatomy or alignment, joint instability, underlying muscle weakness or imbalance, or if they are overweight and engage in significant amounts of exercise.

Individuals who have experienced sports injuries to joints, or macrotrauma, may also be at risk of accelerated development of osteoarthritis. Certain types of surgery for the treatment of severe sports injuries, particularly to the knee, also appear to be associated with an increased risk. If surgery to the knee is required, continuous passive motion is an ideal form of rehabilitative treatment, as it promotes healing of the articular cartilage, ligaments and tendons.Moreover, athletes who have undergone surgery should return slowly to sporting activities to ensure they do not place too much stress on their injured joint(s). Further research into the causes of osteoarthritis is required; in particular, prospective and retrospective cohort studies are needed to confirm the association between exposure to risk factors and the development of osteoarthritis.

This is a preview of subscription content, access via your institution.

References

  1. Finch C, Ozanne-Smith J, Williams F. The feasibility of improved data collection methodologies for sports injuries. Report number 69. Melbourne: Monash University Accident Research Centre, 1995

    Google Scholar 

  2. Avery JG, Harper P, Ackroyd S. Do we pay too dearly for our sport and leisure activities? An investigation into fatalities as a result of sporting and leisure activities in England andWales 1982–1988. Soc Public Health 1990; 104: 417–23

    Article  CAS  Google Scholar 

  3. Lane NE. Exercise: a cause of osteoarthritis. J Rheumatol 1995; 22 Suppl. 43: 3–6

    Google Scholar 

  4. Buckwalter JA, Lane NE. Athletics and osteoarthritis. Am J Sports Med 1997; 25 (6): 873–81

    PubMed  Article  CAS  Google Scholar 

  5. Moskowitz RW, Howell DS, Goldberg VM, et al. Osteoarthritis: diagnosis and management. Philadelphia: M.B. Saunders Company, 1984

    Google Scholar 

  6. Panush RS, Lane NE. Exercise and the musculoskeletal system. Bailleires Clin Rheum 1994; 8 (1): 79–102

    Article  CAS  Google Scholar 

  7. Panush RS, Brown DG. Exercise and osteoarthritis. Sports Med 1987; 11: 199–213

    Google Scholar 

  8. Arthritis Foundation of Victoria. Osteoarthritis: something can be done. Caulfield South (VIC): Arthritis Foundation of Victoria, undated

  9. Dieppe P. Introduction. In: Klippel JH, Dieppe PA, editors. Rheumatology. St Louis (MO): Mosby, 1994: 2.1–2

    Google Scholar 

  10. Anderson J, Felson DT. Factors associated with osteoarthritis of the knee in the First National Health and Nutrition Examination Survey. Am J Epidemiol 1988; 128: 179–89

    PubMed  CAS  Google Scholar 

  11. Hoffman DF. Arthritis and exercise. Prim Care 1993; 20 (4): 895–910

    PubMed  CAS  Google Scholar 

  12. Lane NE, Buckwalter JA. Exercise: a cause of osteoarthritis? Rheum Dis Clin North Am 1993; 19 (3): 617–33

    PubMed  CAS  Google Scholar 

  13. Cooper C. Epidemiology. In: Klippel JH, Dieppe PA, editors. Rheumatology. St Louis (MO): Mosby, 1994: 3.1–4

    Google Scholar 

  14. Vingard E, Alfredsson L, Goldie I, et al. Sports and osteoarthritis of the hip: an epidemiologic study. Am J SportsMed 1993; 21 (2): 195–200

    Article  CAS  Google Scholar 

  15. Panush RS, Inzinna JD. Recreational activities and degenerative joint disease. Sports Med 1994; 17 (1): 1–5

    PubMed  Article  CAS  Google Scholar 

  16. Spector TD, Harris PA, Hart DJ, et al. Risk of osteoarthritis associated with long-term weight-bearing sports. Arthritis Rheum 1996; 39 (6): 988–95

    PubMed  Article  CAS  Google Scholar 

  17. Lindberg H, Roos H, Gardsell P. Prevalence of coxarthrosis in former soccer players. Acta Orthop Scand 1993; 64 (2): 165–7

    PubMed  Article  CAS  Google Scholar 

  18. Kujala UM, Kaprio J, Sarna S. Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes. BMJ 1994; 308 (22): 231–4

    PubMed  Article  CAS  Google Scholar 

  19. Bollen SR, Wright O, Wright V. Radiographic changes in the hands of rock climbers. Br J Sports Med 1994; 28 (3): 185–6

    PubMed  Article  CAS  Google Scholar 

  20. Sohn RS, Micheli LJ. The effect of running on the pathogenesis of osteoarthritis of the hips and knees. Clin Orthop 1985; 198: 106–9

    PubMed  Google Scholar 

  21. Lane NE. Long distance running, bone density and osteoarthritis. JAMA 1986; 255: 1147–51

    PubMed  Article  CAS  Google Scholar 

  22. Marti B, Knobloch M, Tschopp A, et al. Is excessive running predictive of degenerative hip disease? Controlled study of former elite athletes. BMJ 1989; 299: 91–3

    PubMed  Article  CAS  Google Scholar 

  23. Konradsen L, Hansen EB, Sondergaard L. Long distance running and osteoarthritis. AmJ Sports Med 1990; 18 (4): 379–81

    Article  CAS  Google Scholar 

  24. Panush RS, Schmidt C, Caldwell J, et al. Is running associated with degenerative joint disease? JAMA 1986; 255 (9): 1152–4

    PubMed  Article  CAS  Google Scholar 

  25. Stenlund B. Shoulder tendinitis and osteoarthritis of the acromioclavicular joint and their relation to sports. Br J Sports Med 1993; 27 (2): 125–30

    PubMed  Article  CAS  Google Scholar 

  26. Olsen O, Vingard E, Koster M, et al. Etiologic fractions for physical work load, sports and overweight in the occurrence of coxarthrosis. Scand J Work Environ Health 1994; 20: 184–8

    PubMed  Article  CAS  Google Scholar 

  27. Kujala UM, Kettunen J, Paanenen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 1995; 38 (4): 539–46

    PubMed  Article  CAS  Google Scholar 

  28. Vingard E, Alfredsson L, Malchau H. Lifestyle factors and hip arthrosis: a case referment study of body mass index, smoking and hormone therapy in 503 Swedish women. Acta Orthop Scand 1997; 68 (3): 216–20

    PubMed  Article  CAS  Google Scholar 

  29. Vingard E, Hogstedt C, Alfredsson L, et al. Coxarthrosis and physical work load. Scand J Work Environ Health 1991; 17: 104–9

    PubMed  Article  CAS  Google Scholar 

  30. Vingard E. Overweight predisposes to coxarthrosis: body-mass index studied in 239 males with hip anthroplasty. Acta Orthop Scand 1991; 62: 106–9

    PubMed  Article  CAS  Google Scholar 

  31. Vingard E, Alfredsson L, Malchau H. Osteoarthritis of the hip in women and its relationship to physical load from sports activities. Am J Sports Med 1998; 26 (1): 78–82

    PubMed  CAS  Google Scholar 

  32. Lawrence JS, Bremner JM, Bier F. Osteoarthritis: prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966; 25: 1–24

    PubMed  CAS  Google Scholar 

  33. Moretz JA, Harlan SD, Goodrich J, et al. Long-term follow-up of knee injuries in high school football players. Am J Sports Med 1984; 12 (4): 298–300

    PubMed  Article  Google Scholar 

  34. Chantraine A. Knee joint in soccer players: osteoarthritis and axis deviation. Med Sci Sports Exerc 1985; 17 (4): 434–9

    PubMed  Article  CAS  Google Scholar 

  35. Neyret P, Donell ST, Dejour D, et al. Partial meniscectomy and anterior cruciate ligament rupture in soccer players: a study with minimum 20-year follow-up. Am J SportsMed 1993; 21 (3): 455–60

    Article  CAS  Google Scholar 

  36. Deacon A, Bennell K, Kiss ZS, et al. Osteoarthritis of the knee in retired, elite Australian rules footballers. Med J Aust 1997; 166: 187–90

    PubMed  CAS  Google Scholar 

  37. Meir RA, McDonald KN, Russel R. Injury consequences from participation in professional rugby league: a preliminary investigation. Br J Sports Med 1997; 31 (2): 132–4

    PubMed  Article  CAS  Google Scholar 

  38. Hart DP, Dahners LE. Healing of the medial collateral ligament in rats: the effects of repair, motion and secondary stabilizing ligament. J Bone Joint Surg Am 1987; 69 (8): 1194–9

    PubMed  CAS  Google Scholar 

  39. Bullough PG. Pathology. In: Klippel JH, Dieppe PA, editors. Rheumatology. St Louis (MO): Mosby, 1994: 7.1–8

    Google Scholar 

  40. Caterson B, Lowther DA. Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. Biochimica et Biophysia Acta 1978; 540: 412–22

    Article  CAS  Google Scholar 

  41. Handley CJ. Physiological responses to injury: synovial joint structures. In: Zuluaga M, Briggs C, editors. Sports physiotherapy: applied science and practice. Canberra (ACT): Churchill Livingstone, 1995: 61–7

    Google Scholar 

  42. Salter RB. The biological concept of continuous passive motion of synovial joints: the first 18 years of basic research and its clinical application. In: Ewing JW, editor. Articular cartilage and knee joint function: basic science and arthroscopy. New York: Raven Press, 1990: 335–53

    Google Scholar 

  43. Salter RB, Simmonds DF, Malcolm BW, et al. The biological effect of continuous passive motion on the healing of fullthickness defects in articular cartilage. J Bone Joint Surg Am 1980; 62 (8): 1232–51

    PubMed  CAS  Google Scholar 

  44. Salter RB, Ogilvie-Harris DJ, Bogoch ER. Further studies in continuous passive motion [abstract]. Orthop Trans 1978; 212: 292

    Google Scholar 

  45. Palmoski MJ, Brandt KD. Running inhibits the reversal of atrophic changes in canine knee cartilage after removal of a leg cast. Arthritis Rheum 1981; 24 (11): 1329–37

    PubMed  Article  CAS  Google Scholar 

  46. Buckwalter JA, Rosenberg LC, Hunziker EB. Composition, structure, response to injury and methods of facilitating repair. In: Ewing JW, editor. Articular cartilage and knee joint function: basic science of arthroscopy. New York: Raven Press, 1990: 19–56

    Google Scholar 

  47. Buckwalter JA, Mow V. Cartilage repair as treatment of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, editors. Osteoarthritis: diagnosis and management. Philadelphia (PA): WB Saunders, 1992

    Google Scholar 

  48. Rangger C, Kathrein A, Klestil T, et al. Partial meniscectomy and osteoarthritis: implications for treatment of athletes. Sports Med 1997; 23 (1): 61–8

    PubMed  Article  CAS  Google Scholar 

  49. Cox JS, Codell LD. The degenerative effects of medial meniscus tears in dogs’ knees. Clin Orthop 1977; 125: 236–42

    PubMed  Google Scholar 

  50. Busch MT. Meniscal injuries in children and adolescents. Clin Sports Med 1990; 9 (3): 661–80

    PubMed  CAS  Google Scholar 

  51. Mow VC, Ateshian GA, Ratcliffe A. Anatomic form and biomechanical properties of articular cartilage of the knee joint. In: Finerman GAM, Noyes FR, editors. Biology and biomechanics of the traumatized synovial joint: the knee as a model. Rosemont (IL): American Academy of Orthopaedic Surgeons, 1992: 55–81

    Google Scholar 

  52. Jorgensen U, Sonne-Holm S, Lauridsen F, et al. Long-termfollowup of menisectomy: a prospective longitudinal study. J Bone Joint Surg Br 1987; 69 (1): 80–3

    PubMed  CAS  Google Scholar 

  53. Hede A, Larsen E, Sandberg H. Partial versus total meniscectomy. J Bone Joint Surg Br 1992; 74 (1): 118–21

    PubMed  CAS  Google Scholar 

  54. Rangger C, Klestil T, Gloetzer W, et al. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 1995; 23 (2): 240–4

    PubMed  Article  CAS  Google Scholar 

  55. St Pierre DMM. Rehabilitation following arthroscopic meniscectomy. Sports Med 1995; 20 (5): 338–47

    PubMed  Article  CAS  Google Scholar 

  56. DeHaven KE. Rationale for meniscus repair or excision. Clin Sports Med 1985; 4 (2): 267–73

    PubMed  CAS  Google Scholar 

  57. Lynch MA, Hennig CE, Glick KR. Knee joint surface changes.: long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop 1983; 172: 148–53

    PubMed  Google Scholar 

  58. Sommerlath KG. Results of meniscal repair and partial meniscectomy in stable knees. Int Orthop 1991; 15: 347–50

    PubMed  Article  CAS  Google Scholar 

  59. Hoshikawa Y, Kurosawa H, Fukubayashi T, et al. The prognosis of meniscectomy in athletes: the simple meniscus lesions without ligamentous instabilities. Am J Sports Med 1983; 11 (1): 8–13

    PubMed  Article  CAS  Google Scholar 

  60. Roos H, Lindberg H, Gardsell P, et al. The prevalence of gonarthrosis in former soccer players an its relation to meniscectomy. Am J Sports Med 1994; 22: 219–22

    PubMed  Article  CAS  Google Scholar 

  61. O’Reilly S, Jones A, Doherty M. Muscle weakness and osteoarthritis. Rheumatology 1997; 9: 259–62

    Google Scholar 

  62. McDaniel WJ, Dameron TB. Untreated ruptures of the anterior cruciate ligament: a follow-up study. J Bone Joint Surg Am 1980; 62 (5): 696–705

    PubMed  Google Scholar 

  63. Noyes FR, Mooar PA, Matthews DS, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 1983; 65 (2): 154–62

    Google Scholar 

  64. Sherman MF, Warren RF, Marshall JL, et al. A clinical and radiological analysis of 127 anterior cruciate insufficient knees. Clin Orthop 1988; 227: 229–37

    PubMed  CAS  Google Scholar 

  65. O’Connor BL, Visco DM, Brandt KD. The development of experimental osteoarthritis (OA) in dogs with extensively deafferented knee joints [abstract]. Arthritis Rheum 1989; 32: S106

    Google Scholar 

  66. O’Connor BL, Visco DM, Brandt K, et al. Neurogenic acceleration of osteoarthritis: the effects of previous neurectomy of the articular nerves on the development of osteoarthritis after transection of the anterior cruciate ligament in dogs. J Bone Joint Surg Am 1992; 74 (3): 367–76

    PubMed  Google Scholar 

  67. Sommerlath K, Odensten M, Lysholm J. The late course of acute partial anterior cruciate ligament tears: a nine to 15-year follow-up evaluation. Clin Orthop 1992; 281: 152–8

    PubMed  Google Scholar 

  68. McDaniel WJ, Dameron TB. The untreated anterior cruciate ligament rupture. Clin Orthop 1983; 172: 158–63

    PubMed  Google Scholar 

  69. Shelbourne KD, Patel DV, McCarroll JR. Management of anterior cruciate ligament injuries in skeletally immature adolescents. Knee Surg Sports Traumatol Arthrosc 1996; 4 (2): 68–74

    PubMed  Article  CAS  Google Scholar 

  70. O’Brien WR. Degenerative arthritis of the knee following anterior cruciate ligament injury: role of the meniscus. Sports Med Arthrosc Rev 1993; 1: 114–8

    Article  Google Scholar 

  71. Mitsou A, Vallianatos P. Reconstruction of the anterior cruciate ligament using a patellar tendon autograft: a long term follow-up. Int Orthop 1996; 20: 285–9

    PubMed  Article  CAS  Google Scholar 

  72. Johnson RJ, Eriksson E, Haggmark T, et al. Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop 1984; 183: 122–40

    PubMed  Google Scholar 

  73. Patel DV, Aichoroth PM, Al-Duri ZA. The natural history of anterior cruciate ligament injuries in children and adolescents. J Bone Joint Surg Br 1993; 75 Suppl. I: 31–2

    Google Scholar 

  74. Sommerlath K, Lysholm J, Gillquist J. The long-term course after treatment of acute anterior cruciate ligament ruptures: a 9 to 16 year follow-up. Am J Sports Med 1991; 19 (3): 156–62

    PubMed  Article  CAS  Google Scholar 

  75. Fitzgibbons RE, Shelbourne KD. ’Aggressive’ nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 1995; 23 (2): 156–9

    PubMed  Article  CAS  Google Scholar 

  76. Graf BK, Lange RH, Fujisaki CK, et al. Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and before and after attempted conservative treatment. Arthroscopy 1992; 8 (2): 229–33

    PubMed  Article  CAS  Google Scholar 

  77. McCarroll JR, Rettig AC, Shelbourne KD. Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 1988; 16: 44–7

    PubMed  Article  CAS  Google Scholar 

  78. Arnheim DD, Prentice WE. Rehabilitation techniques. In: Smith JM, editor. Principles of athletic training. 9th ed. St Louis (MO): Mosby, 1997: 344–63

    Google Scholar 

  79. Dieppe P. Management. In: Klippel JH, Dieppe PA, editors. Rheumatology. St Louis (MO): Mosby, 1994: 8.1–8

    Google Scholar 

  80. Panush RS, Brown DG. Exercise and arthritis. Sports Med 1987; 4: 54–64

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Caroline Finch.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Saxon, L., Finch, C. & Bass, S. Sports Participation, Sports Injuries and Osteoarthritis. Sports Med 28, 123–135 (1999). https://doi.org/10.2165/00007256-199928020-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199928020-00005

Keywords

  • Anterior Cruciate Ligament
  • Adis International Limited
  • Articular Cartilage
  • Anterior Cruciate Ligament Injury
  • Soccer Player