Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review

Abstract

Objective: Information regarding the relative risks of developing knee osteoarthritis (OA) as a result of sport participation is critical for shaping public health messages and for informing knee-OA prevention strategies. The purpose of this systematic review was to investigate the association between participation in specific sports and knee OA.

Data sources: We completed a systematic literature search in September 2012 using 6 bibliographic databases (PubMed; Ovid MEDLINE; Journals@Ovid; American College of Physicians Journal Club; Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Database of Abstracts of Reviews of Effects; and Ovid HealthStar), manual searches (4 journals), and reference lists (56 articles).

Study selection: Studies were included if they met the following 4 criteria: (1) an aim was to investigate an association between sport participation and knee OA; (2) the outcome measure was radiographic knee OA, clinical knee OA, total knee replacement, self-reported diagnosis of knee OA, or placement on a waiting list for a total knee replacement; (3) the study design was case control or cohort; and (4) the study was written in English. Articles were excluded if the study population had an underlying condition other than knee OA.

Data extraction: One investigator extracted data (eg, group descriptions, knee OA prevalence, source of nonexposed controls).

Data synthesis: The overall knee-OA prevalence in sport participants (n = 3759) was 7.7%, compared with 7.3% among nonexposed controls (referent group n = 4730, odds ratio [OR] = 1.1). Specific sports with a significantly higher prevalence of knee OA were soccer (OR = 3.5), elite-level long-distance running (OR = 3.3), competitive weight lifting (OR = 6.9), and wrestling (OR = 3.8). Elite-sport (soccer or orienteering) and nonelite-sport (soccer or American football) participants without a history of knee injury had a greater prevalence of knee OA than nonexposed participants.

Conclusions: Participants in soccer (elite and nonelite), elite-level long-distance running, competitive weight lifting, and wrestling had an increased prevalence of knee OA and should be targeted for risk-reduction strategies.

Keywords: athletic injuries; epidemiology; injury; injury prevention.

Figure 1.

Study selection. An electronic search with automatic elimination of duplicates and manual search of table of contents identified 17 901 records. Among the 69 full-text articles screened, most articles (n = 40) were eliminated due to the study design or a definition of osteoarthritis that did not meet the inclusion criteria. We evaluated 29 articles with a qualitative analysis and 17 articles with quantitative methods.

Figure 2.

Prevalence (%) of knee osteoarthritis by injury status and level of play among soccer athletes and controls (no history of soccer participation). Prevalence was calculated using the raw data from Figure 1 of Roos et al (1994).