Blog Post Author Biography:  Erik Wikstrom is an Associate Professor and Athletic Trainer at the University of North Carolina at Chapel Hill.  Dr. Wikstrom has spent the last 20+ years studying the consequences of and optimizing interventions for ankle sprains and chronic ankle instability.

Citation:  Paget L, Aoki H, Kemp S, Lambert M, Readhead C, Stokes K, Viljoen W, Reurink G, Tol J, Kerkoffs G, Gouttebarge V.  Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study.  BMJ Open. 2020;10:e036775.  Doi:10.1136/bmjopen-2020-036775.

Take-to-the-clinic message: A history of severe ankle injury and/or ankle surgery increases a professional footballer’s risk of ankle osteoarthritis (OA).  Educating professional footballers, and all athletes, about the long-term risks of ankle injuries and surgeries will be critical to engaging athletes in ankle injury prevention as well as proper treatment protocols post injury and post operatively.  While the presence of ankle OA did not reduce mental or physical quality of life at the time of assessment (~5 years post retirement, ~36 years of age) the impact of ankle OA later in life has been shown to be more severe in other investigations. 

Background: Ankle injuries are very common in football (soccer) and rugby.  Previous ankle injuries, including ankle sprains, are an important risk factor for ankle OA and the presence of OA, in any joint, has been associated with poor mental and physical health-related quality of life.  However, there is limited data on how ankle injuries and surgeries relate to ankle OA and quality of life in retired football and rugby players.

Purpose: The aims of the study were to determine: i) the prevalence of ankle OA in recently retired professional football and rugby players, ii) the association between ankle injury, ankle surgery, and ankle OA, and iii) differences in mental and physical quality of life between those with and without ankle OA.

Methods: A cross-sectional questionnaire based observational study of recently retired male professional football and rugby players was conducted.  A total of 401 foot and 152 rugby players volunteered and completed the survey (response rate of 56%).  The survey captured demographics, severe ankle injury and ankle surgery history, presence of an ankle OA diagnosis, and quality of life via the PROMIS General Health short form. A logistic regression determined the association between severe ankle injuries and surgeries with ankle OA after adjusting for age and BMI while Mann-Whitney U tests compared quality of life between those with and without ankle OA.

Results: Recently retired professional footballers and rugby players were more likely to have ankle OA than the general population.  Retired football, but not rugby, players with a history of severe ankle injuries and/or ankle surgeries had an increased risk of developing ankle OA compared to their counterparts who did not sustain such injuries or undergo ankle surgeries.  The presence of ankle OA did not reduce mental or physical quality of life of recently retired footballers who were about 5 years post retirement.

Rolling the field forward: This research is part of a growing body of evidence highlighting the long-term negative impact of ankle injuries and surgeries among both athletes and the physically active.  This knowledge helps to further emphasize the need to educate athletes and other stakeholders on the importance of primary and secondary preventive measures for ankle injuries in order to reduce the burden of such injuries after the athlete’s playing career and later in life.

Question for the researchers: Why did the authors choose a whole body questionnaire instead of a region-specific questionnaire such as the Foot and Ankle Ability Measure?  With hindsight, do the authors believe that a more region-specific questionnaire may have been more sensitive to potential quality of life declines in this relatively young sample?