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Does sports participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis
  1. Gui Tran1,
  2. Toby O Smith2,
  3. Adam Grice1,
  4. Sarah R Kingsbury1,
  5. Paul McCrory3,
  6. Philip G Conaghan1,4,5
  1. 1Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  2. 2Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
  3. 3The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre—Austin Campus, Heidelberg, Australia
  4. 4NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
  5. 5Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK
  1. Correspondence to Professor Philip G Conaghan, Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; p.conaghan{at}


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.

  • Osteoarthritis
  • Sport
  • Elite performance
  • Risk factor
  • Injury

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Twitter Follow Toby Smith at @tobyosmith

  • Contributors PGC, AG and PM conceived the study. GT, AG, SRK and TOS conducted the study and drafted the manuscript. All authors approved the final manuscript.

  • Funding This study was funded through an Arthritis Research UK Experimental Osteoarthritis Treatment Centre grant (Ref 20083) and the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis grants (Ref 20194). PGC, SRK and GT are supported by the National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit. This article presents independent research funded by the NIHR.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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