Lower limb clinical osteoarthritis and its association with joint pain and function, and severe injuries and surgeries, in women professional football players: a cross-sectional observational study

Ramagole, D., Janse van Rensburg, D. C., Bennett, P., Cowie, C., Maas, M., Mehta, R., Ramkilawon, G., Rantanen, J., Salo, J., Pluim, B., Kerhoffs, G., & Gouttebarge, V. (2025).

South African Journal of Sports Medicine37(1).

Background: Athletes may sustain severe injuries and need to undergo surgery, potentially leading to osteoarthritis (OA). Early diagnosis and rehabilitation can significantly improve outcomes and extend an athlete’s career.

Objectives: To determine: 1) prevalence of clinical hip, knee, and ankle OA; 2) association with pain and function; 3) association with severe injuries and surgeries in female professional footballers.

Methods: This cross-sectional study involved female professional footballers who completed online questionnaires on joint pain and function, severe injuries, and surgeries. Their physicians evaluated them for clinical OA (cOA) of the hips, knees, and ankles.

Results: Among 74 participants, cOA prevalence of the hips, knees, and ankles was 2.7% (95% CI: 0-6.4), 5.0% (95% CI: 2.5-10.6), and 8.0% (95% CI: 1.9-14.3), respectively. Pain was present in the hips (p=0.615; Cramer’s V=0.132), knees (p=0.556; Cramer’s V=0.171), and ankles (p=0.028; Cramer’s V=0.391). Joint function was impaired in the hips (p=0.379; Cramer’s V=0.214), knees (p=0.738; Cramer’s V=0.103), and worse in the ankles (p=0.0778; Cramer’s V=0.255). A weak association existed between hip cOA and injuries (p=0.230; Cramer’s V=0.193), with moderate associations in the knees (p=0.024; Cramer’s V=0.290) and ankles (p=0.168; Cramer’s V=0.206). Surgeries were associated with knee cOA (p=0.0578; Cramer’s V=0.258) and not ankles (p=1.00; Cramer’s V=0.027).

Conclusion: The prevalence of clinical OA was low among female footballers. Pain was the primary symptom, accompanied by impaired joint function. Severe knee injuries and surgeries were linked to cOA. Further research is recommended in this population.