By: 22 December 2017
Retired professional footballers at higher risk of developing knee osteoarthritis

Retired professional footballers are far more prone to develop knee pain and osteoarthritis and face problems with their knees earlier in life than the average person, a study has revealed.

The research was led by academics at the University of Nottingham and funded by the charity Arthritis Research UK with collaborative support from FMARC (FIFA’s Medical and Research Centre), the Professional Footballers’ Association (PFA) and SPIRE Healthcare Group.

The study reported that male ex-footballers were two to three times more likely to suffer from knee pain and knee osteoarthritis and require a total knee replacement, even after adjustment for other risk factors including significant knee injury. Ex-footballers reported more knee pain, structural knee osteoarthritis on X-ray and total knee replacements across all age groups in the study and especially in younger age groups (40–54 years).

Published in the British Journal of Sports Medicine, the research also revealed that although former footballers presented with more musculoskeletal pain, they were less likely to suffer with and report other conditions or diseases such as diabetes, heart attacks and cancer.

The study was led by Gwen Fernandes and Michael Doherty who are part of the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis and are based in the department of Academic Rheumatology in the University’s School of Medicine.

Professor Mark Batt, Director of the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, and part of the research team, said: “This was a well-conducted study powered to investigate both the positive and negative effects of playing professional football. The research will allow us to more accurately communicate both the associated benefits and risks to those involved in the industry.”

More than 1,200 ex-footballers with an average age of 59 years were recruited via the PFA and from individual league clubs and professional football associations in the UK and compared to more than 4,000 general population men from the East Midlands region with an average age of 62.8 years.

Other novel findings include: ex-footballers had more osteoarthritis in the end joints of their fingers (nodal OA); were more likely to have an index finger shorter than their ring finger — also known as a pattern three-digit ratio, which has been previously linked to osteoarthritis risk; and reported significantly more body pain, knee misalignment and use of painkillers.

The research suggested that there could be modifiable risk factors such as obesity management and not engaging in other high-risk occupations post-retirement from professional football. Reducing the number of significant knee injuries in professional football would also have an important impact on the development of knee pain, knee osteoarthritis and the requirement for a knee replacement.

The study concludes that the ‘repetitive microtrauma’ of professional football, regardless of significant injury, is likely to be the main cause of increased risk of knee osteoarthritis. The reported degree of increased adjusted risk (at least doubled) is in the order required by many national bodies to recognise knee osteoarthritis as an industrial disease for professional football.