Fußballsport als Risikofaktor für nicht unfallbedingte Gonarthrose – Ergebnisse eines systematischen Review mit Metaanalyse

Zusammenfassung

Zielstellung und Hypothese: Anliegen dieses systematischen Review mit anschließender Metaanalyse war es, den Einfluss des aktiven Fußballsports auf das Kniearthroserisiko (Relevanz als Berufserkrankung) zu untersuchen. Als Hypothese wurde formuliert: Fußballer leiden auch dann unter einem erhöhten Risiko für eine Gonarthrose, wenn sie keine dokumentierten Makroverletzungen des Kniegelenks erlitten haben.

Methode: Für das systematische Literaturreview und die anschließende Metaanalyse wurden die PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklisten eingehalten. Zum Stichtag 1.2.2014 wurde eine systematische Recherche in den Datenbanken PubMed, Medline, Cochrane, EMBASE und Web-of-Science durchgeführt. Insgesamt 4649 Publikationen einem „Title-Abstract-Review“ unterworfen und schließlich 6 Publikationen in die Metaanalyse eingeschlossen.

Ergebnisse: Eine Längsschnittuntersuchung an einer Gesamtbevölkerung, die den Einfluss des Fußballsports auf das Gonarthroserisiko untersuchte, wurde nicht gefunden. Ein systematisches Cochrane-Review existierte ebenso nicht. In den Studien, in denen nur diejenigen Fälle berücksichtigt wurden, bei denen keine Makroverletzung stattgefunden hatte, bestand im Vergleich zu den jeweiligen Kontrollgruppen ein signifikant erhöhtes Risiko, eine Gonarthrose zu erleiden: 1,3 (95 % CI 1,0 – 1,7); I² = 37,4 %; p = 0,002. Ohne Adjustierung auf dokumentierte Makroverletzungen oder einen Meniskusschaden haben Fußballer ein signifikant erhöhtes Gonarthroserisiko: (Relatives Risiko = 2,9 [95 % CI 2,0 – 4,1]; I² = 56,3 %; p < 0,001).

Schlussfolgerungen: Im Hinblick auf die große Heterogenität der Belastung des Fußballerknies, aufgrund des Fehlens der Kenntnis über ein belastungskonformes Schadensbild und im Hinblick auf das Fehlen einer „Verdopplung des relativen Risiko in der exponierten Gruppe“ wird derzeit keine „BK-Reife“ und auch kein Tatbestand „wie-BK“ bezüglich der Gonarthrose beim Profifußballer gesehen.

Abstract

Aim and Hyopthesis: This systematic review and the metanalysis were performed to investigate the relation between football activity and the potential risk of knee osteoarthritis (possible occupational disease). It was hypothesised that soccer players suffer more than controls from knee osteoarthritis also in cases with an absence of documented major injuries.

Methods: The review and the metaanalysis were performed accordingly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. On 2014.02.01 a search was conducted within the medical databases PubMed, Medline, Cochrane, EMBASE und Web-of-Science. A total of 4,649 papers underwent a "Title-Abstract-Review". Finally 6 publications were included in the metaanaylsis.

Results: There were no longitudinal community-based studies as well as no Cochrane Reviews regarding the risk of knee osteoarthritis in soccer players. After adjustment of major injuries of the knee, soccer players have a slightly increased risk for knee osteoarthritis: relative risk 1.3 (95 % CI 1.0 – 1.7); I² = 37.4 %; p = 0.002. In contrast, in studies without differentiation of injured and non-injured knees, the relative risk was significantly increased: 2.9 (95 % CI 2.0 – 4.1); I² = 56.3 %; p < 0.001.

Conclusions: Soccer players are a very heterogeneous group. The soccer player’s knee undergoes different loadings including minor and major injuries. But the individual load also strongly depends on the player's status, his position within the football field and many other factors. In the absence of a major trauma the soccer player has only a slightly increased risk for the development of osteoarthritis. Thus we conclude that an injury in professional football does not fulfil the characteristics of an occupational disease.

Schlüsselwörter

Knie - Fußball - Arthrose - Risiko - Berufskrankheit

Key words

knee - football - soccer - osteoarthritis - risk - occupational disease

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