Comparing major joint injuries, interventions and late sequelae in elite male handball players with an age-matched control group

Abstract

Introduction Handball is a contact sport which involves throwing and jumping, exposing players to serious physical stress. There is a high risk of injuries leading to possible long-term sequelae. The aim of this study was to assess the incidence of musculoskeletal injuries in elite male handball players compared with an age-matched control group.

Patients and methods Former elite handball players, who had played on the Swiss national team between 1980 and 1985, answered a questionnaire about injuries, surgical interventions and their current health status. A total of 34 athletes were compared with 58 age-matched volunteers, who only engaged in recreational sports or no sports at all.

Results The mean age of the athletes was 58.4 years (range 52–68 years) and did not differ significantly from the mean age of the control group of 58.7 years (range 53–69 years). In the control group, 70 % engaged in recreational sports. There was no statistical difference regarding the life-long incidence of shoulder injuries and surgical interventions, sequelae or persistent shoulder pain. Athletes had more interventions after elbow injuries (0.09 vs. 0, p = 0.047), but the difference with respect to chronic pain or late sequelae was not statistically significant. For knee injuries, there were no significant differences regarding the incidence of injuries or interventions, the prevalence of secondary consequences or persistent pain. Concerning the foot and ankle, there was a significantly higher incidence of injuries (0.5 vs. 0.03, p < 0.001) and interventions (0.5 vs. 0.09, p < 0.001) in athletes, but no statistical difference regarding sequelae or persistent pain. Overall quality of life had identical ratings in both groups (athletes mean 85.9 %, controls mean 85.8 %).

Discussion Top handball players did not sustain more shoulder or knee injuries than the age-matched control group. The elbow was more at risk in these top athletes, but long-term consequences appeared to be less severe. The most distinctive difference was seen in foot and ankle injuries.

Conclusions A career as an elite handball player had no adverse effect on the overall quality of life of elite handball players 25 to 30 years after retiring from professional sports.

Zusammenfassung

Einleitung Handball ist ein Kontaktsport, bei dem geworfen und gesprungen wird und die Spieler ernsthaften körperlichen Belastungen ausgesetzt werden. Es besteht ein hohes Verletzungsrisiko, das zu möglichen Langzeitfolgen führen kann. Ziel dieser Studie war es, die Inzidenz von Verletzungen des Bewegungsapparats bei männlichen Handballspielern im Vergleich zu einer altersentsprechenden Kontrollgruppe zu untersuchen.

Patienten und Methoden Ehemalige Elite-Handballer, die zwischen 1980 und 1985 in der Schweizer Nationalmannschaft gespielt hatten, beantworteten einen Fragebogen zu Verletzungen, chirurgischen Eingriffen und ihrem aktuellen Gesundheitszustand. Insgesamt 34 Athleten wurden mit 58 altersentsprechenden Freiwilligen verglichen, die nur im Freizeitsport oder sportlich überhaupt nicht aktiv waren.

Ergebnisse Das Durchschnittsalter der Athleten betrug 58,4 Jahre (Bereich 52–68 Jahre) und unterschied sich nicht signifikant vom Durchschnittsalter der Kontrollgruppe mit 58,7 Jahren (Bereich 53–69 Jahre). In der Kontrollgruppe nahmen 70 % am Freizeitsport teil. Es gab keinen statistischen Unterschied in Bezug auf das lebenslange Auftreten von Schulterverletzungen und chirurgische Eingriffe, Folgeschäden oder anhaltende Schulterschmerzen. Sportler hatten nach Ellbogenverletzungen mehr Eingriffe (0,09 vs. 0; p = 0,047), die Differenz zu chronischen Schmerzen oder Spätfolgen war statistisch jedoch nicht signifikant. Es wurden keine signifikanten Unterschiede in der Inzidenz von Verletzungen oder Eingriffen sowie in der Prävalenz von Sekundärfolgen oder anhaltenden Schmerzen am Knie festgestellt. In Bezug auf Fuß und Sprunggelenk war die Häufigkeit von Verletzungen (0,5 vs. 0,03; p < 0,001) und Interventionen (0,5 vs. 0,09; p < 0,001) bei Athleten signifikant höher, es gab jedoch keinen statistischen Unterschied für Spätfolgen oder anhaltende Schmerzen. Die Gesamtlebensqualität war in beiden Gruppen identisch (Sportler durchschnittlich 85,9 %, Kontrollpersonen durchschnittlich 85,8 %).

Diskussion Top-Handballer hatten nicht mehr Schulter- oder Knieverletzungen als die altersentsprechende Kontrollgruppe. Der Ellbogen war bei diesen Spitzensportlern stärker gefährdet, die langfristigen Folgen schienen jedoch weniger schwerwiegend zu sein. Der deutlichste Unterschied wurde bei Fuß- und Knöchelverletzungen festgestellt.

Schlussfolgerung Eine Karriere als Elite-Handballspieler hatte 25 bis 30 Jahre nach dem Ausscheiden aus dem Profisport keine nachteiligen Auswirkungen auf die allgemeine Lebensqualität.

Key words

team handball - ageing athlete - epidemiology - ankle - shoulder - elbow

Schlüsselwörter

Handball - alternder Sportler - Epidemiologie - Knöchel - Schulter - Ellbogen

Publication History

Article published online:
20 August 2020

• References

• 1 Arliani G, Astur D, Yamada R. et al Early osteoarthritis and reduced quality of life after retirement in former professional soccer players. Clinics 2014; 69 (09) 589-594 DOI: 10.6061/clinics/2014(09)03.
• 2 Arliani GG, Astur DC, Yamada RKF. et al Professional football can be considered a healthy sport?. Knee Surgery, Sport Traumatol Arthrosc 2016; 24 (12) 3907-3911 DOI: 10.1007/s00167-015-3636-2.
• 3 Armenis E, Pefanis N, Tsiganos G. et al Osteoarthritis of the Ankle and Foot Complex in Former Greek Soccer Players. Foot Ankle Spec 2011; 4 (06) 338-343 DOI: 10.1177/1938640011422595.
• 4 Bere T, Alonso J-M, Wangensteen A. et al Injury and illness surveillance during the 24^th Men’s Handball World Championship 2015 in Qatar. Br J Sports Med 2015; 49 (17) 1151-1156 DOI: 10.1136/bjsports-2015-094972.
• 5 Chakravarty EF, Hubert HB, Lingala VB. et al Long Distance Running and Knee Osteoarthritis A Prospective Study. Am J Prev Med 2008; 35 (02) 133-138 DOI: 10.1016/j.amepre.2008.03.032.
• 6 Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sport Med 2001; 35: 402-408
• 7 Elleuch MH, Guermazi M, Mezghanni M. et al Knee osteoarthritis in 50 former top-level footballers: A comparative (control group) study. Ann Réadaptation Médecine Phys 2008; 51 (03) 174-178 DOI: 10.1016/j.annrmp.2008.01.003.
• 8 Fernandes GS, Parekh SM, Moses J. et al Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study. Br J Sports Med 2017; DOI: 10.1136/bjsports-2017-097503.
• 9 Gouttebarge V, Aoki H, Kerkhoffs GMMJ. The Physician and Sportsmedicine. 2018; DOI: 10.1080/00913847.2018.1451718.
• 10 Jones ME, Davies MAM, Leyland KM. et al Osteoarthritis and other long-term health conditions in former elite cricketers. J Sci Med Sport 2017; DOI: 10.1016/j.jsams.2017.10.013.
• 11 Jost B, Zumstein M, Pfirrmann CWA. et al MRI findings in throwing shoulders: Abnormalities in professional handball players. Clin Orthop Relat Res 2005; 434: 130-137 DOI: 10.1097/01.blo.0000154009.43568.8d.
• 12 Klünder KB, Rud B, Hansen J. Osteoarthritis of the hip and knee joint in retired football players. Acta Orthop Scand 1980; 51 (06) 925-927
• 13 Kujala UM, Kettunen J, Paananen H. et al Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 1995; 38 (04) 539-546 DOI: 10.1002/art.1780380413.
• 14 L’Hermette M, Polle G, Tourny-Chollet C. et al Hip passive range of motion and frequency of radiographic hip osteoarthritis in former elite handball players. Br J Sport Med 2006; 40: 45-49 DOI: 10.1136/bjsm.2005.019026.
• 15 Lohkamp M, Kromer TO, Schmitt H. Osteoarthritis and joint replacements of the lower limb and spine in ex-professional soccer players: A systematic review. Scand J Med Sci Sports 2017; 27 (10) 1038-1049 DOI: 10.1111/sms.12846.
• 16 Lohmander LS, Englund PM, Dahl LL. et al The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries. Am J Sports Med 2007; 35 (10) 1756-1769 DOI: 10.1177/0363546507307396.
• 17 Luig P, Bloch H, Burkhardt K. et al VBG-Sportreport. 2018
• 18 Malinauskas R, Dumciene A, Mamkus G. et al Personality Traits and Exercise Capacity in Male Athletes and Non-Athletes. Percept Mot Skills 2014; 118 (01) 145-161 DOI: 10.2466/29.25.PMS.118k13w1.
• 19 Maquirriain J, Ghisi JP, Amato S. Is tennis a predisposing factor for degenerative shoulder disease? A controlled study in former elite players. Br J Sports Med 2006; 40 (05) 447-450 DOI: 10.1136/bjsm.2005.023382.
• 20 Paxinos O, Karavasili A, Delimpasis G. et al Prevalence of Knee Osteoarthritis in 100 Athletically Active Veteran Soccer Players Compared With a Matched Group of 100 Military Personnel. Am J Sports Med 2016; 44 (06) 1447-1454 DOI: 10.1177/0363546516629648.
• 21 Pfirrmann D, Herbst M, Ingelfinger P. et al Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train 2016; 51 (05) 410-424 DOI: 10.4085/1062-6050-51.6.03.
• 22 Roos H, Lindberg H, Gärdsell P. et al The Prevalence of Gonarthrosis and Its Relation to Meniscectomy in Former Soccer Players. Am J Sports Med 1994; 22 (02) 219-222 DOI: 10.1177/036354659402200211.
• 23 Sarna S, Kaprio J, Kujala UM. et al Health status of former elite athletes. The Finnish experience. Aging (Milano) 1997; 9 (01) 35-41
• 24 Schär MO, Dellenbach S, Pfirrmann CW. et al Many Shoulder MRI Findings in Elite Professional Throwing Athletes Resolve After Retirement. Clin Orthop Relat Res 2018; 476 (03) 620-631 DOI: 10.1007/s11999.0000000000000042.
• 25 Schmitt H, Brocai DRC, Lukoschek M. High prevalence of hip arthrosis in former elite javelin throwers and high jumpers: 41 athletes examined more than 10 years after retirement from competitive sports. Acta Orthop Scand 2004; 75 (01) 34-39 DOI: 10.1080/00016470410001708060.
• 26 Shepard GJ, Banks AJ, Ryan WG. Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries. Br J Sport Med 2003; 37: 80-81
• 27 Singh V, Trewartha G, Roberts S. et al Shoulder Injuries in English Community Rugby Union. Int J Sports Med 2016; 37 (08) 659-664 DOI: 10.1055/s-0042-104414.
• 28 Taubert M, Wenzel U, Draganski B. et al Investigating Neuroanatomical Features in Top Athletes at the Single Subject Level. PLoS One 2015; 10 (06) e0129508 DOI: 10.1371/journal.pone.0129508.
• 29 Teitz CC, Kilcoyne RF. Premature osteoarthrosis in professional dancers. Clin J Sport Med 1998; 8 (04) 255-259 DOI: 10.1097/00042752-199810000-00001.
• 30 Vigdorchik JM, Nepple JJ, Eftekhary N. et al What Is the Association of Elite Sporting Activities with the Development of Hip Osteoarthritis?. Am J Sports Med 2017; 45 (04) 961-964 DOI: 10.1177/0363546516656359.
• 31 te Wierike SCM, van der Sluis A, van den Akker-Scheek I. et al Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: A systematic review. Scand J Med Sci Sports 2012; 23 (05) DOI: 10.1111/sms.12010.