BACKGROUND The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA). METHODS This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA). RESULTS 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40-2.34) and TKR (OR 2.21, 95% CI 1.43-3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85-2.01). Given, the association with KP and TKR, we found a significant dose-response relationship as the more injections a player received (by dose-response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01). CONCLUSION On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.

中文翻译：

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在英国职业足球运动员的职业生涯中以及与职业后膝骨关节炎的联系中进行关节内注射管理。

背景技术在诸如前足球运动员之类的专业运动员中，膝关节内（KIA）注射的长期风险仍然未知。起亚注射剂的使用是有争议的，并且由于它被认为是安全/有益的，因此仍然是多产的。这项研究的目的是确定退役职业足球运动员在其职业生涯中以及与职业生涯后膝骨关节炎（KOA）相关的注射次数，类型和频率。方法这是一项横断面研究，涉及邮政问卷（n = 1207）和随后的膝部X光片，随机抽取了问卷回应者（n = 470）。足球运动员在问卷中自我报告了他们是否接受过起亚注射剂以及整个职业生涯的估计总数。还记录了参与者的特征和与足球职业有关的细节。KOA的测量方法为自我报告的膝关节疼痛（KP），全膝关节置换（TKR）和X线照相KOA（RKOA）。结果44.5％的足球运动员在职业生涯中至少接受了一次起亚注射（平均7.5； SD±11.2）。膝盖注射的71％基于可的松/皮质类固醇。多因素logistic回归，对年龄，体重指数（BMI）和严重膝关节损伤进行调整后，发现注射足球的人患KP（OR 1.81，95％CI 1.40-2.34）和TKR（OR 2.21，95％ CI 1.43-3.42）。但是，与RKOA没有关联（OR 1.30，95％CI 0.85-2.01）。鉴于与KP和TKR的关联，我们发现了显着的剂量反应关系，因为球员接受的注射次数越多（按剂量反应组），在调整膝关节损伤和其他混杂因素后，KP和TKR结果的风险越大（趋势<0.01，p值）。结论平均而言，前足球运动员在职业生涯中共进行了8次起亚注射。最常用的注射剂是基于可的松。这些注射剂在退休后与KP和TKR有关。关联与膝盖受伤无关，并且与剂量有关。这项研究表明，可能已经过度使用起亚（KIA）注射来加快比赛速度，这不利于长期发展，例如职业橄榄球退役后的KP和TKR。调整膝关节损伤和其他混杂因素后，KP和TKR结果的风险越大（趋势<0.01）。结论平均而言，前足球运动员在职业生涯中共进行了8次起亚注射。最常用的注射剂是基于可的松。这些注射剂在退休后与KP和TKR有关。关联与膝盖受伤无关，并且与剂量有关。这项研究表明，可能已经过度使用起亚（KIA）注射来加快比赛速度，这不利于长期发展，例如职业橄榄球退役后的KP和TKR。调整膝关节损伤和其他混杂因素后，KP和TKR结果的风险越大（趋势<0.01）。结论平均而言，前足球运动员在职业生涯中共进行了8次起亚注射。最常用的注射剂是可的松类药物。这些注射剂在退休后与KP和TKR有关。关联与膝盖受伤无关，并且与剂量有关。这项研究表明，可能已经过度使用起亚（KIA）注射来加快比赛速度，这不利于长期发展，例如职业橄榄球退役后的KP和TKR。最常用的注射剂是可的松类药物。这些注射剂在退休后与KP和TKR有关。关联与膝盖受伤无关，并且与剂量有关。这项研究表明，可能已经过度使用起亚（KIA）注射来加快比赛速度，这不利于长期发展，例如职业橄榄球退役后的KP和TKR。最常用的注射剂是基于可的松。这些注射剂在退休后与KP和TKR有关。关联与膝盖受伤无关，并且与剂量有关。这项研究表明，可能已经过度使用起亚（KIA）注射来加快比赛速度，这不利于长期发展，例如职业橄榄球退役后的KP和TKR。