By Jordana Bieze Foster
A history of knee or ankle injury is associated with an increased risk of medical issues—and not just those related to joint health—in middle age and later decades of life, according to research presented in June at the annual meeting of the National Athletic Trainers Association (NATA) in Baltimore, MD.
Not only are people older than 40 years who report a history of knee or ankle injury more likely than their uninjured counterparts to have osteoarthritis (OA), they are also more likely to have a cardiovascular or respiratory disease, the researchers found.
The findings underscore the long-term importance of prevention and early intervention with regard to knee and ankle injuries, said study author Phillip Gribble, PhD, ATC, an associate professor and director of the Division of Athletic Training at the University of Kentucky in Lexington.
“Once these patients leave our care and get into their forties and fifties, it’s not such a simple problem,” Gribble said. “We need to do a better job with prevention and treatment.”
Investigators from the University of Kentucky and the University of North Carolina at Charlotte (UNCC) surveyed more than 3500 adults recruited through the online service research match.org, who ranged in age from 18 to 80 years. Of those, 1843 reported a history of ankle injury, 647 reported a history of knee injury requiring surgery, and 1046 reported a history of both ankle and knee injuries.
Rates of ankle OA were higher for survey respondents with a history of ankle injury (9.4%) than their uninjured counterparts (1.8%), and rates of knee OA were higher for those with a history of knee surgery (54.4%) than those with no knee injury (5.1%). Participants in their 40s and older were significantly more likely to have ankle OA if they also had a history of ankle injury than if they didn’t; similarly, individuals in middle age and older were also more likely to have knee OA if they also had a history of knee surgery or knee injury.
More surprising were the associations found between knee or ankle injury and cardiovascular or respiratory comorbidities. Survey respondents were more likely to report a cardiorespiratory condition if they had a history of ankle injury (30.9%) than if they didn’t (24.5%), and if they had a history of knee surgery (39.3%) than no history of knee injury (23.5%). The age distribution patterns for comorbidities were similar to the patterns for OA, with group differences emerging between ages 40 and 59 years.
“If we’re going to intervene in these patients, not only do we need to be optimizing joint health, we also need to be optimizing overall general health,” said Abbey Thomas, PhD, ATC, an assistant professor in the Department of Kinesiology at UNCC, who presented the knee injury findings at the NATA meeting.
In study participants with a history of injuries to both the knee and ankle, rates of ankle OA (67.9%) and knee OA (58.5%) were higher than in those with a history of either injury alone. Interestingly, a history of both types of injuries was associated with OA in even younger age groups—starting in the 30s—than a history of either knee or ankle injury alone. A higher percentage of survey respondents with a history of both knee and ankle injuries also reported cardiorespiratory comorbidities than those with knee injury (26.6%) or ankle injury (27.5%) alone.
“We’re seeing these comorbidities across the board, no matter the injury or combination of injuries,” said Steven Pfeiffer, a graduate student in the UNCC Biodynamics Research Lab, who presented the combined-injury findings at the NATA meeting.
Gribble PA, Pfeiffer S, Turner M, et al. Long term consequences of ankle injury in the general population. J Athl Train 2016;51(6 Suppl): S20.
Thomas AC, Pfeiffer S, Turner M, et al. Osteoarthritis and comorbidity prevalence among patients with a history of knee surgery. J Athl Train 2016;51(6 Suppl): S20-S21.
Pfeiffer S, Turner M, Gribble PA, et al. Osteoarthritis and comorbidity prevalence among patients with a history of knee and ankle injuries. J Athl Train 2016;51(6 Suppl): S21.