Osteoarthritis
and sport.

Osteoarthritis is a disease that can affect the whole joint. The cartilage, the tissue that covers the ends of the bones, changes, but the bone and synovial membrane also participate in the disease. The affected joint can become painful, stiff or swollen. R1

Osteoarthritis also affects people who play sport. Age, previous injuries, joint shape and certain individual factors contribute to different osteoarthritis situations. So, understanding your joint helps with treating pain and maintaining activity. R1

Running for pleasure, having played professional football or returning after a ligament tear are very different joint histories. Studies in former elite athletes find more osteoarthritis in certain populations. Level of participation, contact, injuries and years of exposure need to be considered together. E1E3E4

For example, in some athletes, difficulties can appear during a sprint, a jump or a change of direction while walking remains easy. During medical care, it is therefore necessary to find out what the patient wants to achieve. Returning to a walk or returning to competition do not call for the same care at all. R7R8

The case of Andy Murray

In January 2019, at the Australian Open, the famous tennis player Andy Murray explains to journalists the difficulties linked to his hip pain. He even talks about difficulties with simple actions such as putting on his shoes or socks. During this statement, he explains that he will have an operation whose first aim is simply to regain a better quality of life. He understands that there is no guarantee of being able to play at the highest level again. But what he wants is “just to have a better quality of life”. M1

00:10

“Not great…”

Clicking connects to YouTube. The selected passage runs from 00:53 to 01:03.

Open the official video at 00:53 ↗Australian Open · 11/01/2019

After hip resurfacing surgery, he nevertheless manages to win the Antwerp tournament in October 2019. His journey gives a concrete example of the different goals of care (making everyday activities easier, enjoying sport again or possibly pursuing a professional goal). Of course, this individual success does not predict each patient’s individual results, but it illustrates a mindset and a care journey that are present even at the highest level. M3

Pain intensity is not proportional to the abnormalities on an osteoarthritis X-ray. New pain should therefore not automatically be attributed to known osteoarthritis. Depending on the situation, the sports physician may also need to look for other causes (differential diagnosis). R3R4

The sports physician asks about the characteristics of the pain (location, timing, movements that are limited…). The different types of imaging are not systematic; they must respond to each individual situation. R3

Reading the evidence

An X-ray does not tell the whole pain story

Among people with knee pain

15–76 %

had osteoarthritis visible on X-rays.

Among people with radiographic knee osteoarthritis

15–81 %

reported knee pain.

0 %50 %100 %

View the original article figure

Figure 1 shows possible pain sources; the percentages above come from the review’s results. © Bedson & Croft, 2008 · CC BY 2.0 · Unmodified original figure.

An osteoarthritis diagnosis does not automatically mean stopping physical activity. In a study of knee osteoarthritis, patients over 50 who chose to maintain adapted running did not have more radiographic worsening over four years. But be careful: this result only concerns this study and does not guarantee tolerance of every training volume in every patient. E2

Results from recreational running cannot be directly applied to professional sport, and vice versa. Continuing or returning depends on the joint concerned, symptoms, previous injuries and the demands of the sport. E1E5E11E12

A previous ligament tear, a meniscal injury or a fracture can change a joint’s future. Post-traumatic osteoarthritis can sometimes develop in a young person and sometimes long after their injury. Screening is important, although of course a previous sprain does not mean that osteoarthritis will necessarily appear. E6E8

Instability can sometimes appear after ligament reconstruction. Ligament reconstruction has therefore not demonstrated protection against osteoarthritis on its own. Rehabilitation remains important after most ligament operations. In the SUPER-Knee clinical trial, it was observed that a supervised programme can improve persistent symptoms after reconstruction. E7E10

Yes, physical activity is part of osteoarthritis treatment. An adapted programme should be able to combine muscle strengthening, endurance, mobility and movement control. It is built and adjusted gradually. R2R5

The exercise dose must be adapted because lifting heavier weights does not necessarily relieve the joint more. Often, if overweight or obesity is present, weight management can complement the programme, but losing weight is not a systematic goal for an athlete of normal build. E13R5

Treatments are individualised and depend on each patient. Medicines and different types of injections can be used to relieve pain and complement other appropriate measures. Some situations may require surgery, in consultation with the patient. R9

Today, research is exploring several avenues:
reducing inflammation after an injury,
addressing certain metabolic factors,
changing joint tissues.

The PIKASO trial studies metformin after anterior cruciate ligament reconstruction; another protocol studies early anakinra injections.

All these trials aim to prevent future osteoarthritis and do not constitute preventive treatments that have already been validated. P1P2

Other results concern different populations. Sprifermin increased cartilage thickness measured in a trial, without a significant overall benefit for osteoarthritis symptoms. So, when judging an innovation, we need to distinguish what it changes in an image, but above all what it changes in pain and real-life activity. P3P4