Why do athletes retire early? We analyze joint injuries and how to return to sports after them

Together with the traumatologist-orthopedist of the SM-Clinic, Alisher Zokhirov , we find out what methods of treating injuries exist, in what cases a surgical operation is needed for treatment, how safe and effective it is, and how quickly you can return to sports.

There is no sport without injury. Of the players, midfielders are most at risk.

Joint injury is at risk for both professionals and amateur athletes. “The most common traumatic injuries are complete or partial ruptures of the ligaments of the ankle, knee, wrist, elbow and shoulder joints, less often fractures of the upper and lower limbs,” explains Alisher Zokhirov.

The risk of injury is especially high in contact sports such as football. In a study that tracked all professional football injuries in the United States, it was found that linebackers were most at risk of injury, followed by defensemen by a small margin, then forwards. On average, there was at least one injury per player per year.

The more the joint is loaded, the higher the risk of injury: the articular surfaces become thinner, chronic tendon tears and cracks in the bones from the load may occur. For football players, the legs are most loaded, so hip injuries, on average, account for 30% of all injuries, knee injuries – about 13%, ankle injuries – 12%.

So, Barcelona midfielder Ansu Fati suffered a meniscus tear in his right knee back in 2021 and, after undergoing two surgeries, is only now returning to the game.

Sometimes the prerequisites for severe damage are created by years of excessive load. I immediately remember how Nicolo Barella played unsuccessfully with his heel, hitting his right knee – at first glance, it was nonsense, but the pain was so strong that it forced the Inter midfielder to hastily leave the field in tears. The case turned out to be the so-called jumper’s knee , in which the cartilage of the patella is destroyed. If the cartilage is thinned, then its minimal displacement and impact with the surface of the femur leads to damage and severe pain. At risk are not only football players, but all athletes who have a significant load on the knee joint.

We must not forget about the high probability of shoulder joint injuries in football players: they often collide on the field, and falls can also cause injury. So, in October, a shoulder dislocation deprived Sergi Roberto of the opportunity to play for Barcelona until at least December.

The risk of injury increases with age – this is the reason for the early “retirement” of athletes

The causes of joint damage are not always due to improper technique or overtraining. For example, with some violations, there is a risk of injury even with perfect technique.

“It is worth separately highlighting a group of people with endocrine diseases that require the use of steroid hormones. When taking certain steroid drugs, the bone tissue and ligamentous apparatus become less strong, the risk of injury increases. Even with the slightest injury, a fracture or rupture of the ligaments can occur, ”says an orthopedic traumatologist.

This happened with tennis player Rafael Nadal: the pathology of the structure of the foot not only caused constant pain and chronic injury in the ankle joint, but also “ pulled ” problems with the knees. As a result of improper distribution of loads, tendinitis developed.

Sports activities also become more dangerous due to aging: “With age, bone tissue becomes more fragile, and the ligamentous apparatus becomes less elastic.Significant changes in the structure of bone tissue and ligaments can be recorded from the age of 50. In addition, the reaction time is reduced, we become less dexterous, and therefore the likelihood of injury increases.”

This is also why athletes “retire” early: they are not only inferior to young people in reaction and muscle strength, but are also more prone to injury.

The ability to return to sports depends on the correct choice of treatment strategy. Therefore, Barcelona sends Araujo to the operation

There are methods that allow you to return a person to a normal life with the usual level of physical activity, even with complex injuries.

“There are two main methods of treating injuries: conservative and surgical. The essence of the conservative (or therapeutic) method is the use of fixing bandages, bandages, orthoses, plaster for the period of bone or ligament fusion, which should help damaged tissues grow together on their own, in a natural way.The essence of the surgical method of treatment is the reconstruction of the anatomical integrity of a damaged formation, for example, a ligament or bone, by a surgeon using special tools: in the case of a fracture, fixation is performed with a plate, pin, in case of ligament rupture, fixation with tapes, threads, screws”, – explains Alisher Zohirov.

The possibilities of therapeutic methods are limited. Immobilization does not help with severe ruptures of ligaments and tendons: they simply cannot grow together.

One of the injuries in which therapeutic methods are often powerless is a torn meniscus in the knee joint. The meniscus is a structure that provides shock absorption, that is, during impacts (for example, landing on your feet after a jump), the bones collide with less force, the load is distributed more evenly. If there is a rupture of the meniscus, then it can no longer soften the blows, but its displacement can limit the range of motion in the joint and cause acute pain.

When conservative methods of treatment, such as physiotherapy and nerve blocks (the introduction of a drug that blocks the conduction of nerve impulses), no longer help, the meniscus is removed – this allows you to relieve pain and restore normal range of motion.

“Surgical treatment is indicated in cases where the conservative method will not lead to recovery or will be ineffective.When using the operative method, it is often possible to restore the function of the damaged segment in a shorter time“, – says the traumatologist.

Only a doctor can decide which method is appropriate in a particular case: for example, the success of surgical treatment of a severe tear in the knee joint in young and physically active patients reaches 85% percent, but for the elderly who suffer from degenerative tears, it is better to choose conservative methods of treatment, including physical therapy and pain medication if necessary.

It is important to make the right decision, which is why Barcelona persuaded Ronald Araujo to solve the problem with a surgical method once and for all, even if they missed the 2022 World Cup. Club representatives probably did not want to repeat the stories with Ansu Fati and Samuel Umtiti: the choice of conservative treatment in order to save time only led to big losses for the club, the players could not play and were forced to return to treatment at the height of the season.

Ilzat Akhmetov also tried for a long time to solve the problem with the shoulder joint with conservative methods, physical education and working out the muscles of the shoulder, but the pain returned and in 2020 it was decided to have an operation. Today, Akhmetov not only returned to duty, but also becomes the hero of admiring articles.

Arthroscopy is a gentle type of surgical treatment. You can return to training as early as 3 weeks after surgery.

Previously, medical technology did not guarantee a high chance of success during surgery, so for professional athletes, all treatment often came down to conservative methods: physiotherapy and immobilization. An open operation almost always meant leaving the field.

It is believed that it was the lack of diagnosis and the wrong treatment strategy that ruined Michael Owen’s brilliant football career – an untreated injury in 1999 (rupture of the hamstring) led to chronic joint diseases and caused catastrophic consequences. Everything was so deplorable that after a new injury in 2006, Michael had to undergo surgery to restore the joint with donor tissues. Today’s technology avoids such problems.

In recent decades, more and more surgical interventions have been performed with minimally invasive surgical operations. This is especially important in operations on such a finely tuned mechanism as a joint. If it is possible to refuse an open operation (it gives more room for the surgeon to maneuver, but is associated with greater risks), minimally invasive methods are chosen, in the case of joints, this method is arthroscopy.

“Arthroscopy is a “puncture method”, hence the low invasiveness of the operation”, explains Alisher Zohirov.

Fewer incisions – less blood loss, fewer scars and lower risk of infection, faster healing. In addition, arthroscopy allows you to use not general anesthesia, but spinal anesthesia – the patient remains conscious, but does not feel pain.

All this allows you to reduce the recovery time and quickly return to the usual level of physical activity. “As a rule, you can return to training 2-3 months after the operation, to sports – after six months,” the doctor explains.

The success rate of meniscectomy performed with the help of arthroscopy, according to several studies , is more than 90%. But after arthroscopy of the hip joint, there are more problems – they are usually associated with old age and the presence of arthritis.

Arthroscopy allows diagnosis in difficult cases. Timely diagnosis gave striker Yura Movsiyan another 4 years of active career

Sometimes arthroscopy is used even at a stage when there is no exact diagnosis yet. In difficult cases, ultrasound, CT, and MRI of the joint may not be enough to determine the cause of pain and decreased range of motion. Diagnostic arthroscopy allows you to examine in detail and directly all the structures of the joint and draw a conclusion about their condition.

Accurate diagnosis allows not only to quickly select the right treatment tactics, but also to avoid unnecessary interventions. At the same time, diagnostic arthroscopy allows us to clarify not only the nature of mechanical injuries, but also to determine the source of discomfort and pain, if there is no specific cause, such as trauma, for them. For example, it helps a rheumatologist to clarify the diagnosis: it becomes possible to assess the extent of structural damage caused by osteoarthritis and autoimmune diseases.

So, the forward of Spartak Yura Movsisyan was assigned a diagnostic arthroscopy – the discovered problem was solved immediately, without resorting to a second operation, by plastic surgery of the outer joint capsule. This allowed him to play another 4 years – before receiving another injury, which, together with age, caused the end of his career.

A joint injury is not the end of a career. Just a year after arthroscopy on the ankle, Rafa Nadal reached the Grand Slam final

The low likelihood of side effects and the high speed of recovery after surgery are especially important for professional athletes: the loss of the opportunity to play in just one tournament can cost a career.

Rafa Nadal, for example, underwent ankle arthroscopy in November 2018, and in 2019 he already reached the Grand Slam final.

After shoulder arthroscopy, Stanislav Donets won two more bronze and two silver medals in three world championships in short pools: in Dubai, Istanbul and Doha.

Sports clubs have recently been trying, if there is evidence, to send players with injuries for surgery and not take risks – it is better to skip the season and then play a few years at a decent level than to return with an incompletely resolved problem and let the team down.