Knee injury in women soccer players linked to early osteoarthritis

One of the fastest growing team sports in America, particularly on college campuses, is women's soccer. Of the more than 17 million players participating in organized soccer nationwide, 7 million are female. While offering an equal opportunity playing field for student athletes, soccer has one unfortunate gender bias: women are more susceptible to knee injury. One of the most common is tearing of the anterior cruciate ligament (ACL)--the ligament in the center of the knee that provides stability. In Sweden, where soccer is wildly popular and women have a shot at playing in a professional league, the risk of ACL injury is 3 to 4 times higher per game hour for young female players than for their male counterparts.

As too many soccer players know, tearing this pivotal ligament brings immediate pain and swelling, followed by a nagging fear of the knee suddenly giving-way. A recent study, published in the October 2004 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), provides compelling evidence of serious risk of knee osteoarthritis (OA) and potentially crippling long-term consequences of a torn ACL for young female athletes. Conducted by a team of researchers at Lund University Hospital, and supported, in part, by the Swedish Soccer Federation, this study focused on 103 female soccer players, between the ages of 26 and 40, who had each suffered an ACL injury 12 years earlier, when they were between the ages of 14 and 28.

Each woman consented to knee radiographs, as well as answered questionnaires about her knee-related quality of life. More than half of the women were assessed as having OA of the knee, accompanied by persistent pain and functional limitations. What's more, 60 percent of the players had undergone reconstructive surgery of the torn ligament soon after sustaining their injury. Using various analyses, the researchers found that surgical reconstruction had no significant effect on knee pain or disabling symptoms. The surgical techniques used today for this injury might be more effective in preventing OA, but this has not yet been proven in scientific studies.

The study's leading researcher, L. S. Lohmander, M.D., Ph.D., describes the very high prevalence of pronounced OA among these young ACL-injured women as "alarming," with serious implications for their future. "For many of these women, the OA disease process can be expected to progress over time and the need for an osteotomy or knee arthroplasty may arise well before the age of 50 years in many of these subjects," Dr. Lohmander speculates. "Although joint replacement may be an efficient treatment for knee OA, the risk of aseptic implant loosening and revision is more than 3-fold higher in the patients operated on while younger than age 65 years, than if older than 75 years."

The first long-term study of the risk and complications of OA linked to this common and serious knee injury specifically among women soccer players, its findings emphasize the need for improved efforts at prevention and treatment of this torn ligament. "Randomized, controlled trials are needed in which different surgical techniques and rehabilitation protocols are compared directly with the best nonsurgical treatment," Dr. Lohmander concludes.

Article: "High Prevalence of Knee Osteoarthritis, Pain, and Functional Limitations in Female Soccer Players Twelve Years after Anterior Cruciate Ligament Injury," L. S. Lohmander, A. Ostenberg, M. Englund, and H. Roos, Arthritis & Rheumatism, October 2004; 50:10; pp. 3145-3152.

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