People of all ages are increasingly participating in sporting activities. This is a healthy trend, as sports are well known to be helpful for cardiopulmonary fitness and weight-control. However, with the benefits does come some risk, namely sports injuries. Most sports injuries are mild and temporary, with no long-term effects. Minor sprains and bruises or overuse injuries treated properly may be nuisances but do not necessarily cause any permanent problems. Some injuries, however, may lead to arthritis later in life.
Millions of people are affected by arthritis, a potentially painful and debilitating condition. Arthritis is the result of disease or damage to articular cartilage, the white glistening surface of our bones found in the joints. Articular cartilage is found in all major joints of the body, including the hips, knees, and shoulders, as well as the smaller joints of the upper and lower extremities and even the spine and pelvis. When this normally smooth gliding surface is no longer intact, pain, swelling and stiffness may result. This is what is referred to as arthritis.
Arthritis is usually seen in older people, but is also seen in younger people who either have a less common form of the disease or have suffered an injury. The most common form is osteoarthritis, also referred to as degenerative arthritis. It usually occurs naturally, without any specific prior injury, in older people. However, this form of arthritis is also the type seen after injury. In this case, it may be referred to as post-traumatic osteoarthritis, or wear-and-tear arthritis. Whatever the name, the result is the same – a painful, swollen, stiff, and sometimes enlarged or deformed joint. It can be mild in some people, offering only an occasional reminder of an old sports injury, or it can be severe, causing daily suffering and degrees of disability.
It is important to understand the types of injury that can go on to cause arthritis in later life. The types of injuries that lead to arthritis include direct injury to the cartilage (as in fractured joints) or injuries that alter joint mechanics, increasing the stress on the articular surface. The first type is less common in sports, more often seen in motor vehicle accidents or falls from a great height. In these instances, severe bruising of the cartilage surface may lead to permanent injury and eventual arthritis. It may also occur from a fracture of the bone through the cartilage in the joint. In these cases the joint may heal with irregularity causing the cartilage to wear unevenly and eventually erode, resulting in arthritis. A key factor is that, while cartilage is a living tissue and does respond to injury, its reparative capacity is limited, and any significant damage usually results in a permanent alteration.
The more common way a sports injury leads to arthritis is when a ligament or supporting structure is damaged, causing abnormal mechanics in the joint. This greatly increases the stress on the articular surface, which over time, wears out and causes arthritis. One of the most known examples of this type of this injury is in the knee. With the increased attention of media to the injuries sustained by star athletes, most people have heard of an ACL injury. ACL stands for anterior cruciate ligament, one of the major stabilizers of the knee. The ACL is in the center of the joint and keeps the tibia (lower leg bone) from moving forward on the femur (thigh bone). Commonly an athlete injures the ACL trying to pivot. The result of a torn ACL is generally an unstable knee, one that buckles occasionally, especially with strenuous activities or further participation in sports. This instability abuses the knee, and over time, the articular surfaces are damaged by the abnormal stresses. Once again, the result is eventual arthritis, although the timetable ranges from a short time to many years.
Another knee injury that results in arthritis is torn cartilage. The menisci are a different form of cartilage found in the knee. They are roughly semicircular wedges, two in each knee, that function to cushion the joint, absorbing a great deal of stress, and also more evenly distributes stress across the joint. A torn meniscus alone can be painful and cause swelling and stiffness, leading a patient to seek early surgical treatment. Historically, the entire torn meniscus was removed. We now know that, while this treatment relieves the acute pain and swelling, it eventually predisposes the patient to premature arthritis due to the absence of the protective effects of the menisci. Currently, attempts are made to repair a torn meniscus to remove only the torn part, leaving as much healthy meniscus as possible. Despite these efforts, an injured meniscus may still lead to earlier arthritis.
The next issue is treatment of arthritis due to sports injuries. As is true in most cases, the best treatment is prevention of the injuries. There are a few different methods to prevent sports injuries. The first is proper conditioning. When someone is poorly conditioned or fatigued, the muscles do not protect the joints, and an injury is more likely. It is important for athletes at any level to be properly conditioned for their sport, not only with regards to stamina but also strength and flexibility. Proper nutrition and hydration also come into play. The next aspect of prevention is proper form and technique in the specific sport, assured in part by following the rules of the game. Finally, certain sports offer protective equipment, and this may be of benefit in injury prevention.
Once an injury has been sustained, there are still measures that may prevent arthritis. Avoiding strenuous or demanding activities may decrease the chances of arthritis. In many cases, as in the torn ACL, the problem can be surgically corrected, restoring proper mechanics and thereby hopefully preventing arthritis.
If arthritis does result, there are also many ways to treat the symptoms. The first is activity modification. Occasionally, orthotics or braces may help. Medications such as acetaminophen (Tylenol) or anti-inflammatory medicines such as ibuprofen may offer relief. Physical therapy, including exercises, are sometimes helpful. New over-the-counter nutritional supplements have also shown promise. Occasional joint injections may give some relief. When all other measures have failed, surgery ranging from arthroscopy to joint replacement can be performed. Unfortunately, there is no cure for arthritis, and that is why prevention is the best treatment. n
Dr. (Prof.) Raju Vaishya , a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation. Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions. He has more than 150 published articles in various International and national peer-reviewed medical journals and has been regularly invited to give lectures, chairing sessions,etc. in Orthopaedic conferences around the world. He has been awarded for the best paper publication on nu¬merous occasions by Delhi Orthopedic Association and Apollo Hospitals. His work was recognized in the Limca book of records in 2012, 2013 & 2015 for do¬ing bilateral Total Knee Replacement in 93 years old gentleman, bilateral Total Knee Replacement in the oldest couple in a single sitting, ACL reconstruction on oldest man.