Does sports participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis.
BACKGROUND
To assess the relationship between sport and osteoarthritis (OA), and specifically to determine whether previous participation, in terms of level (elite or non-elite), type of sport, intensity or previous injury, was associated with OA.


METHODS
This systematic review was developed using PRISMA guidelines. Databases were searched (to May 2016). Narrative review and meta-analysis (with risk ratio (RR) and 95% CIs) approaches were undertaken where appropriate. Study quality was assessed using GRADE.


RESULTS
46 studies were included. Narratively, 31 studies reported an increased risk of OA, with 19 demonstrating an increased risk in elite athletes. There was an increased risk after sports exposure (irrespective of type; RR 1.37; 95% CI 1.14 to 1.64; 21 studies). It remained uncertain whether there was a difference in risk of OA between elite and non-elite athletes (RR 1.37; 95% CI 0.84 to 2.22; 17 studies). The risk was higher in soccer (RR 1.42; 95% CI 1.14 to 1.77; 15 studies) but lower in runners (RR 0.86; 95% CI 0.53 to 1.41; 12 studies). 9 studies showed an association with the intensity of sport undertaken and OA. 5 studies demonstrated a higher prevalence of OA following meniscectomies and anterior cruciate ligament tears. Overall, the evidence was of GRADE 'very low' quality.


CONCLUSIONS
There was very low-quality evidence to support an increased relationship between sports participation and OA in elite participants. It is unclear whether there is a difference in risk between elite and non-elite participants with further prospective studies needed to evaluate this. Pooled findings suggested that significant injuries were associated with OA in soccer players.
Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Gui
G
Tran
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
Toby O
TO
Smith
Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Adam
A
Grice
Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Sarah R
SR
Kingsbury
The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre-Austin Campus, Heidelberg, Australia.
Paul
P
McCrory
Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.|NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK.|Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.
Philip G
PG
Conaghan
Elite performance; Injury; Osteoarthritis; Risk factor; Sport
Br J Sports Med. 2001 Dec;35(6):402-8
11726474
Clinics (Sao Paulo). 2014 Sep;69(9):589-94
25318089
J Am Coll Health. 2005 Sep-Oct;54(2):87-94
16255320
Scand J Med Sci Sports. 1999 Oct;9(5):279-84
10512208
BMJ. 1989 Jul 8;299(6691):91-3
2504343
Am J Sports Med. 1998 Jan-Feb;26(1):78-82
9474406
Best Pract Res Clin Rheumatol. 2007 Feb;21(1):59-76
17350544
Am J Sports Med. 1993 May-Jun;21(3):455-60
8346763
Arthritis Rheum. 2003 Apr 15;49(2):228-36
12687515
Br J Sports Med. 2007 Aug;41(8):469-80; discussion 480
17473005
Clin Orthop Relat Res. 1985 Sep;(198):106-9
4028541
Compr Physiol. 2012 Apr;2(2):1143-211
23798298
Scand J Med Sci Sports. 2006 Oct;16(5):329-33
16978252
Med Sci Sports Exerc. 1999 Jul;31(7):1041-6
10416567
Am J Sports Med. 1980 May-Jun;8(3):164-71
7377447
Am J Sports Med. 2009 Jul;37(7):1434-43
19567666
Aging (Milano). 1997 Feb-Apr;9(1-2):35-41
9177584
Am J Sports Med. 1994 Mar-Apr;22(2):219-22
8198190
Am J Sports Med. 2012 Mar;40(3):527-33
22130474
Acta Orthop Scand. 1993 Apr;64(2):165-7
8498177
Br J Sports Med. 1983 Jun;17 (2):84-7
6883024
Ann Rheum Dis. 2009 May;68(5):611-9
19366893
Am J Med. 1990 May;88(5):452-9
2337104
Med Sci Sports Exerc. 1985 Aug;17 (4):434-9
3839890
Rheumatology (Oxford). 2002 Oct;41(10):1155-62
12364636
Foot Ankle Spec. 2011 Dec;4(6):338-43
21965581
Arthritis Rheum. 2004 Oct;50(10 ):3145-52
15476248
J Am Osteopath Assoc. 2006 Jun;106(6):342-5
16790540
JAMA. 1986 Mar 7;255 (9):1147-51
3945033
Am J Sports Med. 2016 Jun;44(6):1447-54
26933134
Orthopedics. 1978 Jan-Feb;1(1):37-42
724225
Int J Sports Med. 2001 May;22(4):275-9
11414670
Am J Sports Med. 1993 Mar-Apr;21(2):195-200
8465912
Br J Sports Med. 2006 May;40(5):447-50
16632577
Am J Prev Med. 2008 Aug;35(2):133-8
18550323
Osteoarthritis Cartilage. 1997 Mar;5(2):75-86
9135819
Br J Sports Med. 2002 Oct;36(5):330-3
12351329
Br J Sports Med. 2003 Feb;37(1):80-1
12547750
Br J Sports Med. 1982 Jun;16(2):80-4
7104560
Curr Sports Med Rep. 2013 Nov-Dec;12(6):381-90
24225523
Ann Readapt Med Phys. 2008 Apr;51(3):174-8
18374445
Br Med J. 1975 May 24;2(5968):424-5
1125566
Am J Sports Med. 1990 Jul-Aug;18(4):379-81
2403186
Ann Rheum Dis. 2004 Mar;63(3):269-73
14962961
Am J Med. 1987 Apr;82(4):772-80
3551605
Acta Orthop Scand. 1980 Dec;51(6):925-7
7211298
Arthritis Rheum. 1995 Apr;38(4):539-46
7718008
Clin J Sport Med. 2003 Jan;13(1):6-10
12544157
Arthritis Rheum. 1996 Jun;39(6):988-95
8651993
Am J Med. 2008 Apr;121(4):324-331.e6
18374692
Sports Med. 2012 Oct 1;42(10):891-905
22827721
Br J Sports Med. 2000 Oct;34(5):332-6
11049141
Acta Orthop Scand. 1995 Jun;66(3):289-91
7604717
BMJ. 1994 Jan 22;308(6923):231-4
8111258
Int J Behav Nutr Phys Act. 2010 May 11;7:40
20459784
J Rheumatol. 1993 Mar;20(3):461-8
8478853
Joint Bone Spine. 2006 Jul;73(4):442-55
16777458
J Clin Epidemiol. 2011 Apr;64(4):383-94
21195583
JAMA. 1986 Mar 7;255 (9):1152-4
3945034
Acta Orthop Scand. 2004 Feb;75(1):34-9
15022803
Osteoarthritis Cartilage. 2015 Feb;23 (2):239-43
25463445
Am J Sports Med. 2001 Jan-Feb;29(1):2-8
11206251
Sports Med. 1999 Mar;27(3):143-56
10222538
J Rheumatol. 1998 Feb;25(2):334-41
9489830