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Abstract & commentary
Synopsis: Former Olympic runners were not at increased risk of either hip or knee arthritis as compared to former team sports athletes or controls.
Source: Kettunen JA, et al. Am J Sports Med. 2001;29:2-8.
This is a retrospective review to investigate lower extremity disability of former elite athletes. In 1995, a questionnaire was sent to 1321 former Finland Olympic track and field, power, and team sport athletes from 1920 through 1965. The athletes were grouped by activity level and by sport played. The control group was age-matched individuals determined to be healthy at the time of their military physical at age 20. The questionnaire was returned by 75% of the athletes and 71% of the controls. All participants were grouped by occupation to determine if an association between occupation and disability existed. The purpose of the study was to determine if an elite running athlete is at greater risk of developing lower extremity disability later in life than other athletes or the general population.
The results showed that hip and knee disability were more common in the elderly than in the young, and those with greater body mass were at greater risk for knee disability. Additionally, those with a history of prior knee ligament injury, meniscus injury, or with an occupation like a farmer or a skilled worker had greater lower extremity disability than controls. Based on the questionnaire, all age-adjusted former athletes had less hip disability than the controls, but former team sport athletes had greater knee disability than all others. Physician diagnosed knee arthritis was higher in team sport athletes, but hip arthritis was diagnosed similarly in all groups.
Comment by James R. Slauterbeck, MD
So is the running athlete at greater risk for lower extremity disability? I often get asked this question in one form or another in my sports medicine clinic. I traditionally have responded by saying, "If your knee has never been seriously injured, or if you have not had knee surgery, you can probably run guilt free. However, if your knee swells or is painful, you should be suspicious of internal damage and consider cross training on a bike or in the swimming pool."
Several strengths are present in this article. The study defines a specific group of elite athletes and stratifies the athletes by sport, injury, and disability. Additionally, age, body mass index, and occupation were recorded and adjusted because these contribute to lower extremity disability. Finally, the questionnaire was returned by a high number of the athletes and controls (75% of the athletes and 71% of the controls).
Some shortcomings are present in addition to those inherent to a retrospective study. Although the control group was healthy at the time of their military physical, I am unsure if they participated in running or team sports later in life. Possibly a better control group would be nonsmoking, normal weight, nonathletic males and females determined by a questionnaire. Additionally, I am unsure if the questionnaire was validated.
In my opinion, the strengths exceed the shortcomings. This article reports on team and individual Olympic athletes from one country to determine if athletes differ in risk for lower extremity disability when compared to controls. The conclusions will be of great interest to many concerned athletes. We can comfortably tell our runners that they may run and remain at low risk for knee and hip disability as long as they remain uninjured. Additionally, we can counsel team sport participants that they are at greater risk for knee disability when compared to individual sport participants.
So does this study affect my patient care? I believe so. Runners are often a well-read group of athletes and can be difficult to treat and counsel. This paper is readable by athletes and physicians and supports ones’ desire to run but warns of the risk of running after significant knee injury.
Dr. Slauterbeck is Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Tex.