ARE THERE LONG-TERM SEQUELAE FROM SOCCER?

Soccer is the most popular sport in the world and is believed to have 40 million amateur participants.³⁶ During the last decade, female soccer has become more popular and now attracts a fair number of women, not the least in North America. In 1995, 194,223 total soccer players were registered in Sweden, 38,174 (20%) of them were women, making female soccer the second largest sport in Sweden. It has been estimated that at least half of the sports injuries in Europe are soccer related.⁶⁰

Osteoarthritis (OA) in the lower extremity as a sequele from soccer is the focus of this review. It is important to point out that the OA discussed is based on the radiographic findings, and there is an inconsistent relation to symptoms.⁶² There are many risk factors for the development of OA, age being the most important.⁶⁹ Sex, race, obesity, biomechanical factors, and inherited susceptibility as well as use and abuse of joints and joint trauma also influence the development of OA.29, 31, 47 The hand, knee, and hip are most frequently involved in OA, and the factors associated with OA differ according to the joint affected.22, 29, 31 Hand and knee OA have a stronger female preponderance, and knee OA also has a more solid association with obesity compared with hip OA.22, 29, 51 Risk factors are probably additive, and Doherty and associates²³ noted an increased risk of developing knee OA after meniscectomy in patients with a postulated systematic factor resulting in interphalangeal OA in the hand. This is in agreement with the findings of a more commonly progressive joint space narrowing in patients with multiple joint involvement.24, 77

Soccer might increase the risk for low extremity OA in two different ways. First, by the increased risk for knee injuries in soccer, such as meniscus and anterior cruciate ligament (ACL) injuries, and second, by the high loading on hip and knee joints that occurs in soccer, especially in high-level soccer.

Joint injury is a known risk factor of OA, so-called secondary or post-trauma OA. A dislocated fracture involving the joint surface might heal in an incorrect position, followed by a joint incongruency and a potent ial risk for an early development of secondary OA. But also joint trauma without skeletal injury, such as soft-tissue trauma and contusion injuries to the joint cartilage, will increase the risk for OA. Many studies have shown early cartilage changes secondary to meniscus and ACL injuries in the knee.2, 6, 27, 28, 37, 39, 40, 64, 69, 72, 73, 76

There is a correlation between heavy physical work, especially if squatting and kneeling is involved, and knee osteoarthrosis.30, 45, 47, 55, 87 The relation between occupational loading and hip OA is also demonstrated,54, 87 for example, the increased prevalence of hip OA in farmers,¹⁰ and ballet dancers.4, 66