Treating Early Hip, Knee, and Ankle Joint Osteoarthritis in Professional and Elite Athletes – What Works? A Scoping Review

Abstract

OBJECTIVE: To summarize the existing evidence regarding the effectiveness of interventions to manage early hip, knee, and ankle osteoarthritis in active elite or professional athletes. DESIGN: Scoping review. DATA SOURCES: Medline (PubMed), SPORTDiscus, ScienceDirect, and Epistomonikos. ELIGIBILITY CRITERIA: Peer-reviewed publications from 2012 to 2023 in English, Dutch, or French that included active elite/professional athletes with osteoarthritis and/or cartilage injury to the hip, knee, and/or ankle joints and outcomes measured using validated tools. OUTCOME MEASURES: Patient-reported outcome scores relating to function and return to sports. RESULTS: Twenty-seven studies were included from 414 identified: two on exercise and rehabilitation, four on joint injections, and twenty-one on surgery. For the “Exercise and rehabilitation” category, the evidence was insufficient to recommend conventional training or whole-body vibration training for patellofemoral pain. For the “Joint injections” category, hip and knee hyaluronic acid injections appear safe and effective for improving symptoms, delaying hip joint degeneration and return to sport in 50% to 100% of athletes. Platelet-rich plasma was not as effective as hyaluronic acid in the knee joint. Strong evidence supported corticosteroids and/or local anaesthetic in relieving knee joint symptoms allowing short-term return to sport but hastening the development of knee osteoarthritis. For the “Surgery” category, there was insufficient evidence to support surgical interventions as effective interventions in the hip, knee, and ankle joints of athletic populations for managing early osteoarthritis and precursor pathology. CONCLUSION: There was insufficient evidence to provide clear recommendations about which interventions are best for managing lower limb osteoarthritis in the elite or professional athlete. JOSPT Open 2024;2(2):71-81. Epub 24 January 2024. doi:10.2519/josptopen.2024.0806