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Return to Play with Degenerative Joint Disease

  • Peter AngeleEmail author
  • Johannes Zellner
  • Johannes Weber
  • Matthias Koch
Chapter

Abstract

Football is one of the most popular sports. Overall, it is associated with a high incidence of injuries. Most injuries affect the lower limbs, and thereby particularly the knee joint is in focus. Direct cartilage trauma and destabilizing soft tissue injuries associated with recurrent microtrauma lead to feasible osteoarthritis in long term.

Concerning the treatment and return to play, focal early osteoarthritis has to be differentiated from diffuse early osteoarthritis and advanced osteoarthritis due to its different treatment protocols.

For an appropriate treatment, knowledge of the criteria of the focal early osteoarthritis and its treatment possibilities are essential to reach a therapeutic decision. Beside non-operative treatment strategies, regenerative cartilage therapy as well as stabilizing soft tissue and unloading bony treatment approaches have to be considered. Due to the regenerative properties, a return to play after full consolidation and absolving an extended rehabilitation programme is possible. If instability persists or regeneration cannot be obtained, an individualized downgrading of sport intensity and impact according to the extent of the remaining injury has to be recommended.

In diffuse early osteoarthritis as well as advanced osteoarthritis, regenerative potential is lost. So, non-operative treatment strategies are symptom based. As long as they present with minor symptoms, continuation of high-impact sport can remain possible to a limited extent. However, to decelerate the progress of degeneration, a downgrading to low-impact sports should be discussed in accordance to the athletes’ career and expectations. Similar to the non-operative treatment, unloading osteotomy is a symptom-related approach for mal-aligned limbs. After bony consolidation, return to play recommendation is consistent with the non-operative advice.

In contrast, replacement strategies reconstruct the degenerated joint. Evidence-based guidelines concerning return to play do not exist up to now. However, there is an expert consensus to reduce the load of sports to a low-impact level.

In summary, continuing playing football is possible at all stages of osteoarthritis. However, the particular affected athlete needs to be informed on the consequences of the joint degeneration and the concomitant symptoms of its progression.

Top Five Evidence Based References

  1. Vannini F, Spalding T, Andriolo L, Berruto M, Denti M, Espregueira-Mendes J et al (2016) Sport and early osteoarthritis: the role of sport in aetiology, progression and treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1786–1796CrossRefPubMedGoogle Scholar
  2. Madry H, Kon E, Condello V, Peretti GM, Steinwachs M, Seil R et al (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24:1753–1762CrossRefPubMedGoogle Scholar
  3. Filardo G, Kon E, Longo UG, Madry H, Marchettini P, Marmotti A et al (2016) Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1775–1785CrossRefPubMedGoogle Scholar
  4. Angele P, Niemeyer P, Steinwachs M, Filardo G, Gomoll AH, Kon E et al (2016) Chondral and osteochondral operative treatment in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1743–1752CrossRefPubMedGoogle Scholar
  5. Papalia R, Del Buono A, Zampogna B, Maffulli N, Denaro V (2012) Sport activity following joint arthroplasty: a systematic review. Br Med Bull 101:81–103CrossRefPubMedGoogle Scholar

References

  1. 1.
    Koch M, Zellner J, Berner A, Grechenig S, Krutsch V, Nerlich M et al (2015) Influence of preparation and football skill level on injury incidence during an amateur football tournament. Arch Orthop Trauma Surg.  https://doi.org/10.1007/s00402-015-2350-3
  2. 2.
    Aus der Funten K, Faude O, Lensch J, Meyer T (2014) Injury characteristics in the German professional male soccer leagues after a shortened winter break. J Athl Train 49:786–793CrossRefPubMedGoogle Scholar
  3. 3.
    Ekstrand J, Gillquist J (1983) Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc 15:267–270CrossRefPubMedGoogle Scholar
  4. 4.
    Ekstrand J, Hagglund M, Walden M (2011) Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 45:553–558CrossRefPubMedGoogle Scholar
  5. 5.
    Hagglund M, Walden M, Ekstrand J (2009) Injuries among male and female elite football players. Scand J Med Sci Sports 19:819–827CrossRefPubMedGoogle Scholar
  6. 6.
    Hagglund M, Walden M, Ekstrand J (2005) Injury incidence and distribution in elite football--a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15:21–28CrossRefPubMedGoogle Scholar
  7. 7.
    Hawkins RD, Fuller CW (1999) A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 33:196–203CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Junge A, Dvorak J (2004) Soccer injuries: a review on incidence and prevention. Sports Med 34:929–938CrossRefPubMedGoogle Scholar
  9. 9.
    John R, Dhillon MS, Syam K, Prabhakar S, Behera P, Singh H (2016) Epidemiological profile of sports-related knee injuries in northern India: an observational study at a tertiary care centre. J Clin Orthop Trauma 7:207–211CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    de Girolamo L, Kon E, Filardo G, Marmotti AG, Soler F, Peretti GM et al (2016) Regenerative approaches for the treatment of early OA. Knee Surg Sports Traumatol Arthrosc 24:1826–1835CrossRefPubMedGoogle Scholar
  11. 11.
    Kraus VB, Blanco FJ, Englund M, Karsdal MA, Lohmander LS (2015) Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage 23:1233–1241CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Madry H, Kon E, Condello V, Peretti GM, Steinwachs M, Seil R et al (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24:1753–1762CrossRefPubMedGoogle Scholar
  13. 13.
    Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:401–406CrossRefPubMedGoogle Scholar
  14. 14.
    Felson DT, Hodgson R (2014) Identifying and treating preclinical and early osteoarthritis. Rheum Dis Clin North Am 40:699–710CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Madry H, Luyten FP, Facchini A (2012) Biological aspects of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 20:407–422CrossRefPubMedGoogle Scholar
  16. 16.
    Angele P, Niemeyer P, Steinwachs M, Filardo G, Gomoll AH, Kon E et al (2016) Chondral and osteochondral operative treatment in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1743–1752CrossRefPubMedGoogle Scholar
  17. 17.
    Demange MK, Sisto M, Rodeo S (2014) Future trends for unicompartmental arthritis of the knee: injectables & stem cells. Clin Sports Med 33:161–174CrossRefPubMedGoogle Scholar
  18. 18.
    Vannini F, Spalding T, Andriolo L, Berruto M, Denti M, Espregueira-Mendes J et al (2016) Sport and early osteoarthritis: the role of sport in aetiology, progression and treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1786–1796CrossRefPubMedGoogle Scholar
  19. 19.
    SP Y, Hunter DJ (2015) Managing osteoarthritis. Aust Prescr 38:115–119CrossRefGoogle Scholar
  20. 20.
    Arokoski JP, Jurvelin JS, Vaatainen U, Helminen HJ (2000) Normal and pathological adaptations of articular cartilage to joint loading. Scand J Med Sci Sports 10:186–198CrossRefPubMedGoogle Scholar
  21. 21.
    Filardo G, Kon E, Longo UG, Madry H, Marchettini P, Marmotti A et al (2016) Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1775–1785CrossRefPubMedGoogle Scholar
  22. 22.
    Tscholl PM, Dvorak J (2012) Abuse of medication during international football competition in 2010 - lesson not learned. Br J Sports Med 46:1140–1141CrossRefPubMedGoogle Scholar
  23. 23.
    Vaso M, Weber A, Tscholl PM, Junge A, Dvorak J (2015) Use and abuse of medication during 2014 FIFA World Cup Brazil: a retrospective survey. BMJ Open 5:e007608CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tscholl P, Feddermann N, Junge A, Dvorak J (2009) The use and abuse of painkillers in international soccer: data from 6 FIFA tournaments for female and youth players. Am J Sports Med 37:260–265CrossRefPubMedGoogle Scholar
  25. 25.
    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM et al (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 22:363–388CrossRefPubMedGoogle Scholar
  26. 26.
    Niemeyer P, Feucht MJ, Fritz J, Albrecht D, Spahn G, Angele P (2016) Cartilage repair surgery for full-thickness defects of the knee in Germany: indications and epidemiological data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 136:891–897CrossRefPubMedGoogle Scholar
  27. 27.
    Angele P, Fritz J, Albrecht D, Koh J, Zellner J (2015) Defect type, localization and marker gene expression determines early adverse events of matrix-associated autologous chondrocyte implantation. Injury 46(Suppl 4):S2–S9CrossRefPubMedGoogle Scholar
  28. 28.
    Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH (2010) Prevalence of chondral defects in athletes’ knees: a systematic review. Med Sci Sports Exerc 42:1795–1801CrossRefPubMedGoogle Scholar
  29. 29.
    Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(Suppl 1):167S–176SCrossRefPubMedGoogle Scholar
  30. 30.
    Kon E, Filardo G, Berruto M, Benazzo F, Zanon G, Della Villa S et al (2011) Articular cartilage treatment in high-level male soccer players: a prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture. Am J Sports Med 39:2549–2557CrossRefPubMedGoogle Scholar
  31. 31.
    Filardo G, Kon E, Perdisa F, Tetta C, Di Martino A, Marcacci M (2015) Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression. Knee 22:36–40CrossRefPubMedGoogle Scholar
  32. 32.
    Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P et al (2015) Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med 43:1575–1582CrossRefPubMedGoogle Scholar
  33. 33.
    Della Villa S, Kon E, Filardo G, Ricci M, Vincentelli F, Delcogliano M et al (2010) Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med 38:68–77CrossRefPubMedGoogle Scholar
  34. 34.
    Giuliani JR, Burns TC, Svoboda SJ, Cameron KL, Owens BD (2011) Treatment of meniscal injuries in young athletes. J Knee Surg 24:93–100CrossRefPubMedGoogle Scholar
  35. 35.
    Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH (2006) Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 22:3–9CrossRefPubMedGoogle Scholar
  36. 36.
    Alvarez-Diaz P, Alentorn-Geli E, Llobet F, Granados N, Steinbacher G, Cugat R (2016) Return to play after all-inside meniscal repair in competitive football players: a minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 24:1997–2001CrossRefPubMedGoogle Scholar
  37. 37.
    Angele P, Kujat R, Koch M, Zellner J (2014) Role of mesenchymal stem cells in meniscal repair. J Exp Orthopaed 1:12CrossRefGoogle Scholar
  38. 38.
    Filardo G, Andriolo L, Kon E, de Caro F, Marcacci M (2015) Meniscal scaffolds: results and indications. A systematic literature review. Int Orthop 39:35–46CrossRefPubMedGoogle Scholar
  39. 39.
    Rodkey WG, DeHaven KE, Montgomery WH III, Baker CL Jr, Beck CL Jr, Hormel SE et al (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90:1413–1426CrossRefPubMedGoogle Scholar
  40. 40.
    Vundelinckx B, Vanlauwe J, Bellemans J (2014) Long-term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee. Am J Sports Med 42:1592–1599CrossRefPubMedGoogle Scholar
  41. 41.
    Marcacci M, Marcheggiani Muccioli GM, Grassi A, Ricci M, Tsapralis K, Nanni G et al (2014) Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study. Am J Sports Med 42:382–388CrossRefPubMedGoogle Scholar
  42. 42.
    Dai B, Mao D, Garrett WE, Yu B (2014) Anterior cruciate ligament injuries in soccer: loading mechanisms, risk factors, and prevention programs. J Sport Health Sci 3:299–306CrossRefGoogle Scholar
  43. 43.
    Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR (2016) Return to work and sport following high tibial osteotomy: a systematic review. J Bone Joint Surg Am 98:1568–1577CrossRefPubMedGoogle Scholar
  44. 44.
    Voleti PB, Degen R, Tetreault D, Krych AJ, Williams RJ (2016) Successful return to sport following distal femoral varus osteotomy. Orthop J Sports Med 4:2325967116S00132CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM et al (2014) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev:Cd004019.  https://doi.org/10.1002/14651858.CD004019.pub4
  46. 46.
    Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112CrossRefPubMedGoogle Scholar
  47. 47.
    Berger RA, Della Valle CJ (2010) Unicompartmental knee arthroplasty: indications, techniques, and results. Instr Course Lect 59:47–56PubMedGoogle Scholar
  48. 48.
    Naouar N, Kaziz H, Mouelhi T, Bouattour K, Mseddi M, Ben Ayeche ML (2016) Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients. Tunis Med 94:66–71PubMedGoogle Scholar
  49. 49.
    van der List JP, McDonald LS, Pearle AD (2015) Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 22:454–460CrossRefPubMedGoogle Scholar
  50. 50.
    Witjes S, Gouttebarge V, Kuijer PP, van Geenen RC, Poolman RW, Kerkhoffs GM (2016) Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis. Sports Med 46:269–292CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S et al (2007) Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 35:1688–1695CrossRefPubMedGoogle Scholar
  52. 52.
    Waldstein W, Kolbitsch P, Koller U, Boettner F, Windhager R (2016) Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-016-4167-1
  53. 53.
    Walker T, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3281–3287CrossRefPubMedGoogle Scholar
  54. 54.
    Papalia R, Del Buono A, Zampogna B, Maffulli N, Denaro V (2012) Sport activity following joint arthroplasty: a systematic review. Br Med Bull 101:81–103CrossRefPubMedGoogle Scholar
  55. 55.
    Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Baldini A, Castellani L, Traverso F, Balatri A, Balato G, Franceschini V (2015) The difficult primary total knee arthroplasty: a review. Bone Joint J 97-b:30–39CrossRefPubMedGoogle Scholar
  57. 57.
    Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D (1997) Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am 79:575–582CrossRefPubMedGoogle Scholar
  58. 58.
    Meding JB, Meding LK, Ritter MA, Keating EM (2012) Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res 470:144–149CrossRefPubMedGoogle Scholar
  59. 59.
    Pavone V, Boettner F, Fickert S, Sculco TP (2001) Total condylar knee arthroplasty: a long-term followup. Clin Orthop Relat Res:18–25Google Scholar
  60. 60.
    Oehler N, Schmidt T, Niemeier A (2016) Total Joint Replacement and Return to Sports. Sportverletz Sportschaden 30:195–203CrossRefPubMedGoogle Scholar
  61. 61.
    Lefevre N, Rousseau D, Bohu Y, Klouche S, Herman S (2013) Return to judo after joint replacement. Knee Surg Sports Traumatol Arthrosc 21:2889–2894CrossRefPubMedGoogle Scholar
  62. 62.
    Mont MA, Rajadhyaksha AD, Marxen JL, Silberstein CE, Hungerford DS (2002) Tennis after total knee arthroplasty. Am J Sports Med 30:163–166CrossRefPubMedGoogle Scholar
  63. 63.
    Kuster MS (2002) Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines. Sports Med 32:433–445CrossRefPubMedGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Peter Angele
    • 1
    • 2
    Email author
  • Johannes Zellner
    • 1
  • Johannes Weber
    • 1
  • Matthias Koch
    • 1
  1. 1.Department of Trauma SurgeryUniversity Medical Centre RegensburgRegensburgGermany
  2. 2.Sporthopaedicum RegensburgRegensburgGermany

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