Summary

Elite male soccer players had greater prominence of the tibial tuberosity, greater posterior tibial slope, and a higher incidence of ossicle associated with Osgood–Schlatter disease and bipartite patella.

Abstract

Background

Soccer players are exposed to high forces on the knee, particularly in the tibial tuberosity from kicking motions during growth. This may affect bone morphology and accessory ossicles; however, little is known about these effects.

Purpose

To identify differences in knee bone morphology and accessory ossicles between soccer players and controls.
Study Design: Cross-sectional study; Level of evidence, 3.

Methods

This study included male professional soccer players who had medical check-ups at our hospital from 2013 to 2023 as the soccer group. Medical check-ups included knee radiographs of the bilateral anteroposterior, lateral, and sky-line views. Male age-matched patients who visited our hospital and had bilateral anteroposterior, lateral knee, and sky-line views radiography were included in the control group. Each radiograph was evaluated to determine the Insall–Salvati ratio (ISR), tuberosity height ratio (THR), posterior tibial slope (PTS), ossicle associated with Osgood–Schlatter disease (OOSD), Sinding Larsen–Johansson disease and bipartite patella (BP). Statistical analyses were performed to determine differences between the soccer and control groups.

Results

This study included 334 and 223 knees were in the soccer and control groups, respectively. THR, PTS, and incidence of OOSD and BP were significantly higher in the soccer group than in the control group (P < .001, P < .001, P = .002, and P = .001, respectively). In the soccer group, THR and PTS were significantly higher on the dominant side than on the non-dominant side (P = .049 and P = .009, respectively). ISR correlated with THR, PTS, and the incidence of OOSD (THR: P < .001, R = -0.1941; PTS: P < .001, R = -0.181; OOSD: P = .006, R = -0.116).

Conclusions

Elite male soccer players had greater prominence of the tibial tuberosity, greater PTS, and a higher incidence of OOSD and BP. Additionally, they had greater tibial tuberosity prominence and PTS on the dominant side. Patella baja was associated with the prominence tibial tuberosity, PTS, and incidence of OOSD.