背景和目标:最近的证据强调了年轻和前职业运动员中膝骨关节炎(kOA)的患病率较高。尽管高要求运动的实践被认为是膝关节软骨退化的诱发因素,关节软骨似乎对中等负荷增加有积极反应。我们的目的是调查运动员早期kOA保守管理的最新证据,特别强调治疗性锻炼和注射治疗,以强调是否有任何适应症可以影响临床和康复实践。材料和方法:进行了范围审查,筛选MEDLINE和PEDro数据库,了解过去二十年来发表的关于该主题的研究。英语学习,使用可访问的摘要,包括在审查中。使用了PICO框架(P患者:运动员,I-干预:保守治疗,治疗性运动或注射疗法,C-比较:不需要,O-结果:临床结果)。临床试验,随机对照试验,并考虑了纵向研究。结果:4项研究最终纳入综述。治疗性运动似乎对预防软骨退变有有益作用,关于减轻疼痛,和身体功能增强。另一方面,在kOA的轻度至中度阶段,关节内补充透明质酸显示出关节疼痛和功能的中长期改善。富含血小板的血浆治疗也显示了长达12个月的疼痛和功能的显着改善。结论:尽管所考虑的研究存在异质性,应采用结合治疗性运动和适度有氧活动(如跑步)的多模式治疗,以预防kOA的发展.在有症状的kOA的情况下,可能需要添加微创注射疗法,这似乎有助于改善运动功能和症状学。
Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping
review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the
review. The PICO framework was used (P-patient: athletes, I-Intervention: conservative treatment with therapeutic exercise or injection therapies, C-Comparison: not needed, O-Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the
review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.