Post-Traumatic Arthritis And Sports Injuries

Are you suffering from immobility and joint pain? That 'hit' you suffered while playing your favourite sport may have caused it. These symptoms may last a few months before you are back on your feet and recovered.

This article provides a comprehensive account of current views on post-traumatic arthritis. It enumerates the causes, symptoms, outcomes, and other valuable information.

Post-traumatic arthritis: an overview

Globally, there is an increase in the incidence and prevalence of post-traumatic arthritis (PTA). Increased mobility and injuries are the main causative factors of PTA.

Post-traumatic arthritis develops after direct trauma to the joints.¹ While wear and tear is the cause of osteoarthritis, younger, healthier, and more active people are more susceptible to PTA. Trauma damages the cartilage of joints and weakens it so the joint cannot bear the stress.

Recovery from such injuries is often spontaneous and may take one to two months. The symptoms that persist for over six months are considered pathological.¹

Types of arthritis

Arthritis means 'disease of the joints'. The types of arthritis are as follows

• Rheumatoid arthritis is an autoimmune disease affecting synovial joints in which bone degeneration occurs
• Osteoarthritis affects elderly and young individuals who have suffered traumatic injuries. The joints commonly affected are the knees, feet, and fingers
• Psoriatic arthritis

Causes of post-traumatic arthritis 

This classification of causes includes 

• Sports injuries
• Accidents
• Falls

Injuries occur in contact sports or sports requiring sudden movements such as twists and turns of the body. Falls and accidents also precipitate similar outcomes.

PTA begins with mechanical injury but progresses due to localized and biological responses. It includes inflammatory mediators released during tissue destruction as well as repair responses. The onset of disease varies for different levels of injuries.⁸

Symptoms of post-traumatic arthritis

• Pain and inability to move the joint
• Swelling over the joint: bleeding within the joint may occur at times
• Sensitivity to touch
• Inability to bear weight

Types of injuries to joints 

• Acute ligament rupture: It occurs in athletes who need frequent and quick changes in the direction of motion while playing games such as basketball or football
• Meniscus tear: It is the most common knee injury
• Shoulder dislocation: It affects people in overhead, throwing, or contact sports
• Patellar dislocation: It poses a problem in young athletes with a high incidence of recurrence
• Ankle instability: The ankle bears more force per centimetre than the hips and knees. It has the lowest rate of injury. The most common injury of the ankle is lateral ligament rupture²

Development of pathology

The degenerative process initiated at the time of injury leads to osteoarthritis. Joint injuries cause alterations in synovial fluid, ligaments, and bone.

In osteoarthritis, changes occurring within a joint could include the following-

• There is degradation of articular cartilage. (Cartilage provides a smooth surface with low friction to permit gliding joint movements⁵
• Thickening of subchondral bone. There is damage to the cartilage as the underlying subchondral bone is exposed. It affects the continuous process of bone remodeling
• Osteophytes or bony spicule formation occurs when the cartilage is lost. The process of remodeling bone becomes erratic and causes the development of osteophytes
• Degeneration of ligaments
• Hypertrophy of joint capsule

Phases of development

• The immediate phase is related to mechanical events
• The acute phase has cell death and inflammation
• The chronic phase has the persistence of joint pain and dysfunction even six months after injury

The inflammatory phase resolves after a couple of months with lifestyle changes. The risk of developing osteoarthritis later remains.

Diagnosis

After the physical examination, we need other investigations as 

• X Rays
• Magnetic Resonance Imaging (MRI) shows bones and tissues around them
• CT Scan gives a detailed picture of bones and surrounding tissues

Management of post-traumatic arthritis

Preventing injuries can minimize the risk of developing arthritis.

Medical management

The first attempts made to manage it are conservative. 

Medical treatment cannot stop the progression of the disease. It helps in managing the symptoms.

The treatment includes 

• Nonsteroidal anti-inflammatory drugs
• Intra Articular cortisone injections
• Use of Glucosamine supplements
• Low-impact exercises
• Lifestyle changes to manage weight

Not all patients benefit from a conservative approach, and chronic arthritis develops in some. If symptoms do not subside, the disease becomes chronic.

Physiotherapy management

Conservative management includes⁴

• Modification in activities
• To offload the joint and seek help from assistive devices
• Exercise to regain flexibility, coordination, and strength
• Managing weight

Protection, rest, ice, compression, and elevation (P.R.I.C.E.) is the traditional protocol for rehabilitation. It aims to avoid tissue damage, pain, and swelling and to promote healing. The protocol to provide rest has a detrimental effect on muscle tone. The current policy replaces rest by optimal loading to (P.O.L.I.C.E). It promotes collagen reorganization and tissue healing. The program to load begins as soon as the pain reduces.⁷

Surgical management

Surgical treatment for arthritis is need-based. It is needed when the quality of life is severely affected. Surgical procedures include

• Debridement (means removing dead tissues)
• Joint Replacement or arthroplasty

Impact of sporting activities on adolescents

The participation of adolescents in sporting activities is beneficial for their development. It improves physical health and psychological and behavioral aspects. However, this participation in sports is associated with the risk of injury: It threatens to have short and long-term effects on the health of athletes.³

Adolescence represents a stage in life that transforms physical, social, and psychological development. Sporting is an important social activity for young adults. They navigate changes in independence and identity through sports. The injuries impact athletes with long-term consequences; they cause loss of connection. The psychological impact of injury includes negative emotions, fear, lack of confidence, and restlessness.³ 

Preventing osteoarthritis after sport-related injuries 

Osteoarthritis causes abnormal joint morphology and weakens musculature with reduced mobility. Physical inactivity leads to obesity in such cases.

Insufficient exercise therapy, premature return to sport, reinjury, and poor nutrition increase the risk of developing osteoarthritis.

Before returning to active sports, the athletes need counseling to manage expectations.

The economic burden of arthritis 

Arthritis ranks among the major leading causes of disability worldwide. At an individual level, it causes pain and immobility that results in obesity and increased cardiovascular risk.

At the societal level, the healthcare burden increases. There may be a need for disability compensation and loss to workforce productivity.⁴

Current trends in preventing sports injuries

There is an increasing concern that too much activity leads to arthritis. Stress caused by physical activity on the joint results in microtrauma.

The onset of osteoarthritis depends upon the frequency, intensity, and duration of physical activity.⁶ High-impact sports over a long period increase the risk of developing osteoarthritis.

Despite the concerns about injury in sports, there has been a marked reduction in injuries. The changes in the sporting environment are the result of increasing safety rules.

Strategies to prevent injury focus on the rules, equipment, and physical fitness. Strength training and balanced psychological programs all contribute to minimizing injury.

FAQs

What to expect if I have post-traumatic arthritis?

Discomfort is inevitable. There may be pain, stiffness, and swelling. Recovery from injury depends upon the trauma that had caused it. Serious injuries take long to recover.

How long does post-traumatic arthritis last?

It takes around a couple of months for symptoms to disappear.

Do I need to miss work?

You should have sufficient rest and not be in a hurry. It may increase the chances of recurrence and future debility. Your physiotherapist/health provider will be the best guide.

What should be my action plan for the future?

Make lifestyle changes, invest in yourself, perform regular exercises, and take all measures to avoid trauma.

Summary

It is impossible to prevent injuries in sports or accidents. The prevention strategies do reduce the severity of injuries. It is mandatory to follow all safety guidelines while performing outdoor activities.

• Wear the appropriate protective equipment for all outdoor activities and sports
• Remove clutter from your home and workspace to prevent tripping
• Fasten your seatbelt while driving

Post-traumatic arthritis causes a shift in daily routines and behaviour. It resolves spontaneously, yet if it does not, it is chronic. 

To conclude in a few words: Prevention is better than cure.