Osteoarthritis of the knee in athletes

Osteoarthritis of the knee is more common among athletes. Several factors can explain this phenomenon: overuse, repeated impacts, recurrent injuries. Physiotherapy for osteoarthritis of the knee can be one of the solutions.

Physical activity is good for healthy cartilage.

Despite this increased incidence, the clinical practice guidelines continue to recommend physical exercise as the main treatment. Several recently published studies have demonstrated the beneficial effect of physical activity on cartilage health (matrix hardness, increased concentration of proteoglycans, increased cartilage thickness). That is why we often recommend physiotherapy for osteoarthritis of the knee.

These studies have also shown that a proper exercise program is often more effective than arthroscopic surgery. Thus, we should not  encourage athletes to  stop everything, but rather encourage them to change their habits by choosing activities better suited to their condition.

Choosing the right exercises

To avoid

First, it is important to avoid repeated impacts (jumps, jogging, direct hits). Then, in symptomatic patients, it will be better to avoid prolonged or excessive activities (marathon, triathlon). Hence, consulting with a clinic offering  physiotherapy for osteoarthritis of the knee is recommended.

To encourage

Rest periods should be encouraged so that the cartilage has time to rebuild itself. Finally, patients that are athletes should ask their physiotherapist to set up an exercise program that focuses on mobility and reinforcement. Some tools, such as the KneeKG, can help correct faulty patterns that cause premature  wear.

Acute period (red, swollen and non-functional knee):

In acute period, anti-inflammatory medication and physiotherapy oriented on analgesic modalities should help contain the pain crisis. If it lasts more than two weeks, do not hesitate to resort to a cortisone injection. Of course, these injections are not supposed to cure osteoarthritis definitively, but they do however make it possible to overcome the inflammatory crisis more quickly, and thus resume the therapeutic exercises.

Glucosamine sulphate effective for osteoarthritis

Some studies have shown the effectiveness of glucosamine sulphate in osteoarthritis of the knee. Since the cartilage is  barely vascularized, the percentage of product ingested orally that ends up in the joint will likely be minimal. In addition, do not expect significant results before 3-4 months.

Impact of viscosupplementation:

As for viscosupplementation (Synvisc, Durolane, Orthovisc, Monovisc and others), it will have repercussions not only on the pain, but also on the function. In addition, a long-term chondroprotective effect is possible, which would thus delay the final step, the total knee prosthesis (TKP).

Viscosupplementation is indicated in mild to moderate osteoarthritis, where the improvement will be nearly 75%. Despite less convincing results in severe osteoarthritis, it remains relevant to try it anyway, because the next step, the TKP, will be much more invasive and will sometimes leave functional sequelae that will compromise the resumption of some physical activities.

Intra-articular injections of platelet-rich plasma (PRP) are sometimes used. They would be more effective for younger patients with mild osteoarthritis. As for the intra-articular injection of stem cells, the preliminary data look particularly promising.

TKP should be delayed as much as possible because of its limited life span (about 15 years in active patients) and some risk of complications. New surgical techniques aiming to maintain the natural angulation of the knee give reasons to hope for better long term results . Some athletes with TKP manage to remain very active provided, again, that they carefully select the appropriate activities.

Doctor Gauthier Michel J.