POSTTRAUMATIC OSTEOARTHRITIS – PTOA
The relationship between sports related joint injuries & developing osteoarthritis, also known as Posttraumatic Osteoarthritis – PTOA, have you been affected?
Remember the time you twisted your ankle while playing tennis or soccer, what about the time you injured your knee playing football in high school, you may not remember but your body does. Although the injury may have healed, the damage can last a lifetime.
Research has found that post-traumatic osteoarthritis is a leading cause of joint disability, and this chronic disease caused by injury and wear and tear of the joints, affects 23% of adults nationwide.
Posttraumatic osteoarthritis is a condition that develops after an acute direct trauma to the joints causing life-long pain and disability for millions of people. The residual joint abnormalities that follow an acute joint injury often lead to posttraumatic osteoarthritis.
Although my focus in this blog relates to posttraumatic osteoarthritis caused from sports related injuries, PTOA can occur as a result of other physical injuries such as a vehicle accident, a fall, a military injury, or other sources of direct physical trauma.
Many younger adults have osteoarthritis – OA, and the numbers are increasing despite previous beliefs that osteoarthritis is a disease of the elderly. There are several risk factors for osteoarthritis among younger individuals, key among them stem from joint injuries caused from participation in sports, and clinical experience shows that participation in sports can produce forces that rupture or cause tears in the tissue. The general view is that OA is the result of wear and tear and because athletes and young individuals use their joints more, the risk is higher.
Despite numerous benefits, sport and exercise participation is a leading cause of lower extremity musculoskeletal injury. These injuries are associated with a variety of negative consequences including a significantly elevated risk of developing posttraumatic osteoarthritis.
With activities such as high intensity workouts becoming more popular, joint health solutions are of increasing relevance. This is being driven largely by the baby boomer population wanting to maintain their mobility and the high rate of supplement use among millennials who are now taking proactive steps to support their joints as part of their overall approach to health and wellbeing.
In young and athletic individuals, the more time they spend engaging in occupational and recreational activities, the higher their predisposition to injuries contributes to their increased likelihood of developing OA. The correlation between sports – joint injuries and the development of posttraumatic osteoarthritis has been well documented, several papers have been written by renowned experts which support this.
Sport and recreational activities account for up to 40% of injuries requiring medical attention, with 50% involving the ankle, knee, or hip. The most commonly injured joint during sporting activities is the ankle followed by the knee. The highest rates of injury are in youth team sports that involve contact, quick changes of direction, or rapid acceleration and deceleration. Beyond the high prevalence of these injuries, there are an increasing number of signs warning that sport and recreational injuries are on the rise.
Joint degeneration occurs in athletes and young individuals through damage to the articular cartilage caused by repetitive impact and loading. This damage often comes from high impact sports like football, soccer, and hockey to name a few. Rotator cuff injuries of the shoulder, ligament injuries and meniscal tears in the knees and ankle sprains are only a couple of examples. Impact loads result from blows applied directly to the joint or to a bone that forms part of the joint. Torsional loads result from twisting or turning of the joint surfaces relative to each other.
It is estimated that more than 50% of individuals diagnosed with any of these injuries will have OA 10 to 20 years later, with pain and some level of functional impairment. In studies of injuries to the knee’s anterior cruciate ligament, or ACL, as many as 80 percent of patients show signs of osteoarthritis in radiographic images within the next 5 to 15 years. Risks rise dramatically even when athletes hurt their knees as teenagers and the older you are when you injure a joint, the more quickly OA is likely to follow.
Loss of articular cartilage may result from a single injury, repetitive injuries or from the progressive degeneration of a synovial joint that follows traumatic damage to joint articular cartilage. In many individual’s posttraumatic osteoarthritis progresses over years to destroy the articular cartilage, leaving only bone wearing against bone for bearing surfaces and causing increasingly severe pain, loss of mobility, and deformity.
Unlike most tissues, articular cartilage does not have blood vessels, nerves, or lymphatics. Articular surfaces have a limited capacity for repair following injury and for responding to alterations in joint mechanics. Fractures that penetrate subchondral bone stimulate a repair response that commonly leads to formation of a new articular surface. Unfortunately, this new articular surface lacks the structure and mechanical properties of the uninjured tissue and is therefore vulnerable to rapid degeneration.
The effects of slowly applied loads and suddenly applied loads on articular cartilage differ considerably. Loading of articular surfaces causes movement of water within the joint matrix that effectively distributes loads within the cartilage and to the subchondral bone. When a load occurs slowly the fluid displaces in response to the applied load, muscle contraction can absorb much of the energy and stabilize joints, the fluid movement allows the cartilage to deform and this decreases the force applied to the joint matrix.
When articular surface loading occurs too rapidly or unexpectedly as with sudden impact or torsional joint loading during sports, muscle contraction may not occur rapidly enough to stabilize joints and decrease the forces on the articular surfaces, the matrix framework sustains a greater share of the stress suggesting that the rate of loading is a critical factor in determining if an injury will cause articular surface damage.
People with hip or knee osteoarthritis in their early years, 20 to 55 are four times more likely to be highly psychologically distressed and report a diminished quality of life than the general population. Most notably, 40 to 49-year-old adults with osteoarthritis report almost a 40% reduction in health-related quality of life.
Besides a societal cost, individuals with posttraumatic osteoarthritis often seek joint replacements 9 to 14 years earlier than other adults with osteoarthritis.
Given that sport and exercise are leading causes of joint injury, individuals who suffer a sport or exercise-related joint injury represent an easily identifiable subset of “at risk” individuals to target with strategies aimed at preventing OA.
Presently there are no approved therapies to address PTOA and prevent the onset of the chronic disease. The primary goals of treating patients with PTOA are to minimize the symptoms and reduce pain. Currently, pharmacological treatments for PTOA include prescription drugs, OTC analgesics such as acetaminophen or anti-inflammatory medications such as NSAIDS, other options are intra-articular injections of hyaluronic acid or cortisone. Not all patients benefit from these treatments and chronic arthritis can develop in the damaged region. If none of these measures are effective, then surgery is the next option, however, any medical or surgical treatment can have severe side effects or risks.
Thanks again for taking the time to read along, after all it’s your health and your health matters.