Post-Traumatic Arthritis in Olympic Athletes
People think Olympics athletes are like superhumans who can overcome all pain and injury. However, years after the games have ended, post-traumatic arthritis will set in those joints injured in the pursuit of gold. The knee crushed on the downhill slopes, the shoulder pounded against the ice hockey rink, the ankle blown-out in a failed triple axel; all of these joints can be damaged beyond repair. The cartilage, the bones and the ligaments; all of these passive, stabilizing structures in the joints have a limited capability for self-repair after being traumatized. Those joints that do not heal back to the original, stable condition will in fact degenerate quickly and become chronically inflamed. This post-traumatic state is called Post-Traumatic Arthritis.
Sometimes the resulting damage from an acute injury sets a joint up for continued, repetitive injury. For example, the knee has two very important structures called the meniscus, which cushion and protect the joint surfaces. Without a properly functioning meniscus, the knee cartilage (articular cartilage), which covers and protects the bones (the tibia and femur), is subject to repetitive injury. That injury predisposes the joint to osteoarthritis in the future. Whether using the term post-traumatic arthritis or osteoarthritis, injury to a joint now can create a painfully inflamed, arthritic joint in the future.
The Olympic athletes of yesteryear are still experiencing the pain of pursuing Olympic gold. How are they adapting and preventing joint arthritis from becoming a debilitating barrier? Some have found alternative activities to outlet their need for competition and sport. Picabo Street, the famous U.S. skier in the late '90’s, has found horseback riding to be a good therapeutic option. Eric Heiden, the famous speed skater, has become an accomplished bicyclist. Both horseback riding and bicycle riding are much easier on the ankles, hips and knees. Additionally, Eric Heiden has also embraced the abilities of nutrition to control pain and inflammation. Many former Olympic athletes have adapted, changed and moved on to a different chapter in life, a chapter that is easier on the joints.
If a joint is beyond any hope of functional use, then what are some of the invasive options that young athletes have for treating post-traumatic arthritis? Some opt for a cartilage transplant, also called a osteochondral allograft. Cartilage is harvested from a donor site and transplanted to the damaged host site. This type of technology has been used successfully for years in treating severely damaged skin. Now, the articular cartilage is the subject for grafting and harvesting. Cartilage transplants can offer an alternative to joint fusion (arthrodesis) and joint replacement (arthroplasty) which are not favored in an athlete under the age of 40 years old. And that really is the core problem with post-traumatic arthritis; this type of arthritis occurs in the young and very active.
No surgeon wants to fuse a joint in a young athlete. No surgeon wants to hope that an artificial joint will last 40 to 50 years. Yet, these are the kind of decisions that a former Olympian faces when the joint becomes too painful from post-traumatic arthritis. At some point in the future, better options will become available that do not require transplantation, fusion or replacement. Growth factors and genetic therapy are on the horizon and will bring back the glitter in many Olympians lives. For now, superhuman or not, the Olympians should take care of their original parts.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.