How to treat osteoarthritis of the knee when you are an athlete?


Gonarthrosis, commonly known as knee osteoarthritis, is more frequent among athletes. Several factors can explain this phenomenon: overuse, repeated impacts, recurrent injuries.

Physical activity is good for a healthy cartilage

Despite this increased incidence, practice guidelines continue to recommend physical exercise as the primary treatment. Several recently published studies have demonstrated the beneficial effect of physical activity on cartilage health (matrix hardness, increased concentration of proteoglycans, and thickening of the cartilage).

These studies also showed that a proper exercise program was often more effective than arthroscopic surgery. Thus, athletes should not be discouraged from staying active, but rather encouraged to change their habits by choosing activities that are better suited to their condition.

What exercises should you choose?

To avoid

First, it is important to avoid repeated impacts (jumping, jogging, direct hits). Then, in symptomatic patients, it is better to avoid prolonged or excessive activities (marathon, triathlon).

To do

Rest periods should be encouraged to give the cartilage time to heal. Finally, the sports patient should ask his or her physiotherapist to build an exercise program that focuses on mobility and strengthening. Some tools, such as the KneeKG device, can help correct defective patterns that cause premature wear.

Acute period (red, swollen and non-functional knee):

In the acute period, anti-inflammatory medication and physiotherapy focused on analgesic modalities should help contain the pain crisis. If this period lasts more than two weeks, do not hesitate to resort to cortisone infiltration. Obviously, you cannot expect these infiltrations to cure osteoarthritis permanently, but they do allow you to get out of the inflammatory crisis faster, and thus resume therapeutic exercises.

Glucosamine sulphate effective for osteoarthritis

Some studies have shown the effectiveness of glucosamine sulphate in gonarthrosis. Since cartilage is barely vascularized, the percentage of product ingested orally that ends up in the joint will probablly be minimal. In addition, you should not expect significant results before three to four months.

Impact of viscosupplementation

As for viscosupplementation (Synvisc, Durolane, Orthovisc, Monovisc and others), it will have repercussions not only on the pain, but also on the function. In addition, the possibility of a long-term chondroprotective effect has been reported, which would make it possible to delay the final stage, i.e. total knee prosthesis (TKP).

Viscosupplementation is indicated for mild to moderate osteoarthritis, where improvement is reported to be nearly 75%. Despite less convincing results in severe osteoarthritis, it remains relevant to try it anyway, because the next step, TKP, is much more invasive and may leave functional sequelae that will compromise the resumption of certain physical activities.

Intra-articular injections of platelet-rich plasma (PRP) are sometimes used. They are thought to be more effective for younger patients with mild degrees of osteoarthritis. As for the intra-articular injection of stem cells, the preliminary data are particularly promising.

TKP should be delayed as much as possible because of its limited life span (about 15 years in active patients) and a certain risk of complications. New surgical techniques aiming at preserving the natural angulation of the knee allow to hope for better long-term results. Some athletes with TKP manage to remain very active provided, again, that they carefully select the appropriate activities.

Doctor Gauthier Michel J.

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