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Review

Proposal for Diet Supplementation to Prevent Knee Osteoarthritis in Female Soccer Players

by
Alberto Caballero-García
1,*,
David C. Noriega-González
2,
Aurora Caballero-Castillo
3 and
Enrique Roche
4,5,6,7,*
1
Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Los Pajaritos, 42004 Soria, Spain
2
Department of Surgery, Ophthalmology, Otorhinolaryngology, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
3
Specialist in Family and Community Medicine, Soria Area Health Management, 42004 Soria, Spain
4
Department of Applied Biology-Nutrition and Institute of Bioengineering, Miguel Hernández University (UMH), 03202 Elche, Spain
5
Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
6
CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
7
Research Group “Nutrition and Physical Activity”, Spanish Nutrition Society “SEÑ”, 28010 Madrid, Spain
*
Authors to whom correspondence should be addressed.
Dietetics 2025, 4(1), 8; https://doi.org/10.3390/dietetics4010008
Submission received: 19 November 2024 / Revised: 6 January 2025 / Accepted: 17 February 2025 / Published: 20 February 2025
Versions Notes

Abstract

:
Soccer is a widely practiced and highly mediatic sport discipline. For this reason, the incidence of injuries associated with the game is an active area of research. High-impact actions occur during the game, affecting the knee joint and resulting in osteoarthritis. In this line, knee osteoarthritis results from mechanical and biological stress due to lesions that are not adequately repaired, resulting in an inflammatory process. This occurs because the degradation of extracellular matrix predominates over synthesis by chondrocytes. Therefore, in soccer players, knee osteoarthritis results from joint traumatic actions, displaying a degenerative evolution. Osteoarthritis occurs in up to 32% of male soccer players, 3 times more than in the male general population. On the other hand, female soccer players are a main target population to suffer from knee osteoarthritis, with a higher significant incidence observed compared to men. In this context, certain diet supplements have an instrumental potential in the prevention and/or treatment of knee osteoarthritis. Therefore, the aim of this narrative review is to present possible research lines to implement treatments for knee osteoarthritis in female soccer players.

1. Introduction

Osteoarthritis is the result of mechanical and biological stresses that destabilize the normal coupling between the degradation and synthesis of extracellular matrix (ECM) by chondrocytes in the articular cartilage and subchondral bone. Osteoarthritis can be initiated by multiple factors, including genetic, environmental, metabolic, and traumatic [1]. Therefore, osteoarthritis is a degenerative joint disease with altered tissue homeostasis of articular cartilage and subchondral bone, where destructive processes predominate. Osteoarthritis usually focuses on the lower extremities, particularly in the knee and hip joints [2]. In addition, osteoarthritis cannot be described as a single disease, but rather as a heterogeneous group of diseases with similar clinical manifestations and common pathological and radiological changes [3].
Osteoarthritis mainly affects movable joints and is characterized by cellular stress and degradation of cartilage of ECM. Osteoarthritis starts with the presence of micro- and macro-injuries that activate maladapted repair responses, generating an inflammatory process [2]. The prevalence of knee osteoarthritis is 5.6% in men under 50 years of age, increases to 9.6% at 60 years and reaches 44.5% in those over 80 years of age. Prevalence is higher in women, with 18% at 60 years and 71.6% in those over 80 years of age [4,5,6]. Recent epidemiological data revealed that the problem of osteoarthritis continues to increase, affecting approximately 7.6% of the global population [7]. In sports practice, the incidence of knee osteoarthritis is also higher in women. This is due to anatomical, biomechanical, and hormonal factors, as well as specific patterns of execution of certain actions (see below).
Osteoarthritis occurs as well in many sports disciplines. Soccer (the topic of this review) is a high-impact sport that poses a significant risk for the long-term development of knee osteoarthritis, particularly due to the intense physical demands placed on the joints [8]. Repetitive stress, frequent twisting, and the potential for injuries such as ligament tears or cartilage damage can all contribute to the early onset of this degenerative condition [9]. Notably, female soccer players represent a high-risk population for knee osteoarthritis, as studies have shown that women are more susceptible to knee injuries, such as tears in the anterior cruciate ligament, which are major precursors to osteoarthritis [10]. This increased risk makes it critical to focus on prevention and early intervention strategies for female athletes. These include an adapted diet to this sports discipline and the corresponding supplement administration. However, these dietary strategies should complement other therapeutic actions, such as electrostimulation, ultrasound, passive stretching, and cryotherapy, among others [11].
Therefore, this narrative review will present the potential of some supplements as candidates to complement diet for the treatment or prevention of knee osteoarthritis. To this end, first we explore the risk factors of knee osteoarthritis, associated pathophysiology, and diagnosis. Then, we present a specific discussion on the aspects of knee osteoarthritis in sport athletes, with special attention to females [12,13]. Finally, certain diet plus supplement recommendations will be presented in order to motivate future research to help reduce the incidence of knee OA.

2. Etiology, Mechanisms and Diagnosis of Knee Osteoarthritis

The knee joint is a complex hinge joint crucial for weight-bearing and locomotion in athletes. Key anatomical structures include the femur, tibia, and patella bones. Articular cartilage covers the ends of these bones, providing a low-friction surface for smooth movement. This tissue possesses limited regenerative capacity due to the lack of blood vessels, nerves, and the post-mitotic state of adult chondrocytes. Two C-shaped fibrocartilaginous structures (medial and lateral menisci) reside within the knee joint, acting as shock absorbers and enhancing joint stability. Ligaments (e.g., cruciate and collateral) connect the bones, providing stability to the joint. Collagen fiber orientation in the ECM, together with the synovial fluid produced by synoviocytes, lubricates the joint. The synovial fluid is retained by proteoglycans. This complex structure contributes to the load-bearing capacity and flexibility instrumental for athletic performance [14].

2.1. Risk Factors in Knee Osteoarthritis

The risk factors for osteoarthritis can be divided into general factors and related to the joint function (Table 1). All these factors interact in a complex manner [15]. Therefore, osteoarthritis is the result of the multifactorial and complex interaction of several variables [16].
Being overweight is the most common modifiable risk factor, because excess weight increases the load on the joints. This results in inflammation that conditions muscle strength and function [16,17,18,19]. In the sport context, high intensity activities that involve kneeling, bending the knee, squatting, and standing for prolonged periods of time are risk factors for knee osteoarthritis. In addition, trauma and previous knee injuries have also been linked to a high prevalence of knee osteoarthritis, particularly in soccer players (main topic of this review) [9]. In this context and regarding sex, female soccer players have a higher incidence of knee injuries than men: 42% [10] vs. 20–30% [20].

2.2. Physiopathology of Osteoarthritis

Osteoarthritis is considered as a joint disease with a complex pathogenesis that affects all tissues integrated in the joint. Its etiology is mainly of traumatic origin and degenerative evolution when osteoarthritis appears in the young population. This is the case of sport practitioners. Hence, regenerative treatment will be necessary for osteoarthritis therapy [8]. On the other hand, old patients differ in the underlying cause of lesions (i.e., traumatic, overuse, metabolic, and degenerative), as well as the length, which likely influences lesion progression [21]. The joint failure that occurs in osteoarthritis is the result of an unbalance between catabolic and anabolic processes in chondrocytes of the articular cartilage, limiting the repair process [22,23]. Decreased synthesis of lubricin and proteoglycans leads to deficient joint lubrication, increasing mechanical friction [24,25,26,27,28]. This situation evolves to inflammation in the synovial membrane, resulting in joint effusion and less water retention [27,28,29,30].
Radiological diagnosis indicates joint space narrowing due to articular cartilage loss and decreased meniscus. Bone changes include subchondral bone sclerosis and the presence of osteophytes [31,32,33]. In addition, the excessive load on the bone can lead to bone marrow injuries, microfractures, necrosis, and fibrosis [34,35]. This degenerative process is favored by the presence of reactive oxygen and nitrogen species (RONS) [36]. Furthermore, chondrocytes can produce a wide variety of inflammatory mediators during osteoarthritis, such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and IL-6. These cytokines attract circulating inflammatory cells to the joint, further promoting the secretion of additional inflammatory factors, favoring disease progression [37,38].

2.3. Diagnosis of Knee Osteoarthritis

The diagnosis of knee osteoarthritis is first based on the medical history, giving special attention to secondary knee conditions that may contribute to increasing the risk and progression of the disease. Clinical diagnosis relies on the presence of typical symptoms, findings from physical examination, laboratory results, and imaging features. None of these signs are exclusive, but the more features that are present, the more accurate the diagnosis [1]. Therefore, diagnosis and the severity grading of knee osteoarthritis are based on clinical data and radiographic imaging [11]. To assess knee status, arthroscopic analysis has to be performed in the different compartments of the knee, analyzing the surfaces separately: medial femoral, medial tibial, lateral femoral, lateral tibial, femoral trochlea, and patella.

3. Knee Osteoarthritis in Athletes

Knee osteoarthritis has been presented as a health problem. However, in sports this pathology has a high impact (Table 2). Certain sports present a higher risk, and soccer is among them (Table 3). Finally, the particular characteristics displayed by women have to be considered in order to present this problem in the population of female soccer players (Table 4). In high-impact disciplines, such as soccer, women undergo a variable load on the joint surface and constant torsion due to jumps, accelerations, decelerations, and changes in direction during running. Legs are the body segments most affected [11]. Factors contributing to knee osteoarthritis in sports practice are summarized in Table 2.
Certain sports carry a higher risk of developing knee osteoarthritis due to repetitive impact, joint overload, and the potential for injuries. The sports with the highest risk are indicated in Table 3.
In the context of sports, female have a higher risk of developing knee osteoarthritis compared to men. Several factors contribute to this increased susceptibility (Table 4).
Therefore, knee osteoarthritis is a common condition among sport practitioners, particularly in female soccer players. This is due to the high demands placed on their knees throughout their careers. Studies have shown that retired players are at a significantly higher risk of developing knee osteoarthritis compared to the general population [44]. Soccer requires multifaceted and continuous changes in direction, characterized by dynamic and repetitive actions involving forward and backward running, sprints, jumping, kicks, and lateral movements [47,48,49,50]. Knee injuries, particularly those involving the anterior cruciate ligament and meniscus, are very prevalent in soccer players, favoring progression to osteoarthritis [51,52,53]. Data indicate that knee osteoarthritis occurs in up to 32% of male soccer players [54,55], displaying 2.3 times higher incidence compared to the general male population [56]. On the other hand, in women’s soccer, over 70% of injuries are classified as traumatic, and the main part of these injuries are located in the lower extremities. Altogether, the knee is the most common site for severe injuries [19,57,58,59,60,61,62,63,64]. Therefore, female soccer players are a candidate population to develop knee osteoarthritis. In this context, only three studies use a multivariate approach to analyze the risk factors for injuries in soccer [19,65,66]. Thus, the prevalence of knee osteoarthritis is 16% in elite soccer players, 4.2% in non-elite players, and 1.6% in controls [67]. On the other hand, female soccer players experience knee injuries at an earlier age than male players. Women tend to have an average age at the time of injury of 19 years compared to 23 years for males [68]. Altogether, the presented information indicates that females are a main target population to suffer from knee osteoarthritis compared to their male counterparts (Table 4) [69,70].

4. Diet and Supplement Strategies to Prevent Knee Osteoarthritis in Female Soccer Players

4.1. Dietetic Considerations in Soccer

As mentioned before, soccer is a high-intensity, intermittent sport that demands a combination of aerobic endurance, anaerobic power, strength, and mental acuity. Proper nutrition plays a pivotal role in enhancing performance, accelerating recovery, and reducing the risk of injury. Taking into account that the caloric cost of a soccer match is around 1000 Kcal, carbohydrates are the primary fuel source for soccer players, especially during high-intensity sprints, repeated accelerations, and quick directional changes. Glycogen stores, mainly in muscles, provide the energy needed to sustain performance, and depletion results in fatigue [71]. Recommendations are that soccer players should consume daily 6–10 g/Kg of carbohydrates, depending on training intensity. Proteins are equally critical for muscle repair and recovery, with an intake of 1.2–2.0 g/Kg [71]. Fats, while not the primary fuel source during matches, contribute to the energy required for prolonged training sessions and should constitute about 20–35% of total caloric intake [71,72].
On the other hand, micronutrients such as iron, calcium, vitamin D, and electrolytes in particular, are instrumental in muscle function, bone health, and oxygen transport. Deficiencies can impair performance and increase injury risk. In addition, hydration is also essential, as even a 2% loss in body weight through sweat can significantly impact cognitive and physical performance. Fluid intake should match sweat losses, and electrolyte replenishment is necessary to avoid cramping and dehydration [71,73].
The timing of nutrient intake can significantly influence performance and recovery. Pre-match meals rich in carbohydrates, consumed 3–4 h before, are key to replenishing glycogen stores. During matches, when the game is stopped, small amounts of carbohydrates, such as energy gels or sports drinks, help maintain blood glucose levels. Post-match recovery focuses on replenishing glycogen stores, repairing muscle tissue, and rehydration. Consuming a meal or snack containing carbohydrates and proteins (in a 3:1 ratio) within 30–60 min post-game is highly effective for recovery. Finally, nutrition strategies should be tailored to individual players, considering factors such as age, gender, body composition, position, and specific metabolic needs. Otherwise said, customized nutrition is instrumental to optimize performance and prevent injuries [74,75].
From a nutritional point, the first strategy recommended to prevent knee injuries is maintaining an optimal weight during performance [76]. This is instrumental for reducing the pressure on the knees, because every extra kilogram significantly increases the load on the joints. In this line, foods have to be rich in anti-inflammatory and antioxidant components (fish, seeds, and vegetables) such as those found in the Mediterranean dietetic pattern [77]. Therefore, diets containing refined sugar, trans fats, and ultra-processed foods can favor inflammation. Nevertheless, the evidence regarding the anti-inflammatory and antioxidant potential of diet is still inconclusive. In addition, adequate hydration is instrumental, because joint cartilage has high water content, and dehydration can negatively affect its function [1]. While there is no definitive nutritional protocol for knee osteoarthritis, several diet supplements could serve as candidates to prevent or slow the progression of the disease, as well as alleviate symptoms in female soccer players (Table 5).
In this context, it has been suggested that the use of certain supplements seems to support physiological tendon renewal, counteracting inflammation and local degeneration [78,79,80,81]. However, others suggest that oral supplements would only help to preserve damaged structures, halting the degenerative process [82]. Altogether and considering the few clinical studies, there are still many aspects to investigate regarding the use of diet supplements in tendon disorders. Considering this information, we analyze the possibilities of certain candidates (Table 5) in the prevention/treatment of knee osteoarthritis in female soccer players. The effects of these diet supplements have been evaluated in other studies by measuring various parameters such as pain, stiffness, function, quality of life, and inflammation markers. Interventions have been conducted on subjects affected by osteoarthritis in general (no sports practitioners), without focusing specifically on the knee.

4.2. Omega-3 Fatty Acids

Omega-3 fatty acids have antioxidant and anti-inflammatory properties, instrumental for optimal post-exercise recovery. In this line, several studies have demonstrated the benefits of their consumption after exercise performance. These benefits include reduced fatigue due to muscle mass preservation and decreased proinflammatory cytokine production through reduced eicosanoid biosynthesis [83]. Preserving muscle mass enhances strength and positively impacts recovery, improving training adaptation. Intervention studies using omega-3 fatty acids show that muscle damage markers, such as creatine kinase (CK) and lactate dehydrogenase (LDH), tend to decrease significantly in the supplemented groups compared to placebo [84,85,86]. However, C-reactive protein also tends to decrease in the supplemented groups. These observations could explain the reduction in delayed-onset muscle soreness, though results are still quite heterogeneous [83]. This variability could be due to different reported doses and supplementation durations, which typically range from 1.4 to 3.6 g/day over periods from 1 day to 26 weeks [83]. In the context of inflammation, omega-3 fatty acids can prevent the nuclear migration of the transcription factor NF-κB, leading to a reduced inflammatory response [87]. In this regard, some inflammatory cytokines, such as interleukin (IL-6), show reduced expression, while others, such as tumor necrosis factor-α (TNF-α), show no changes [83,87]. Additionally, omega-3 fatty acid consumption improves glutathione (GSH) levels, helping to mitigate oxidative stress [83]. Therefore, the first step is to determine the optimal dosage and timing for these supplements to exert an anti-inflammatory effect. Our proposal for female soccer players is that omega-3 fatty acids could be administered preventively during competition phases but could also help mitigate inflammation when knee OA is stabilized. This would allow other supplements to exert optimal reparative action. Altogether, using omega-3 fatty acids to reduce inflammation in OA seems promising based on existing research [83]. Our previous systematic review indicates that some studies show benefits, but results can vary depending on dosage, duration, and individual response [83]. Therefore, more research is needed to establish the optimal conditions for their use to prevent knee osteoarthritis in female soccer players.

4.3. Curcumin

Curcumin and metabolic derivatives are extracted from Curcuma longa rhizome, an herbaceous plant native to Southeast Asia. The biological actions of curcumin are anti-inflammatory, anti-apoptotic, and antioxidant [88]. High-intensity physical activity produces stress and generates significant force in the muscle-tendon unit, increasing the risk of tendinopathies [89]. Eccentric and repetitive muscle contractions promote tendon microtraumas accompanied by inflammation, apoptosis, and vascular and neuronal changes [14]. Degenerative tendinopathy is characterized by progressive extracellular matrix and collagen disorganization. Cellular damage is accompanied by alterations in tendon vascularization, making it unable to withstand tensional stress and rendering it mechanically useless. Additionally, the tissue begins to produce pain-related substances and activates peripheral nerves, causing hypersensitivity [90]. Treatments with oral supplements, such as curcumin (range: 100–200 mg/kg body weight), are frequently used [89]. As mentioned before, curcumin has significant biological actions, including analgesic, anti-inflammatory, and antioxidant effects [91,92,93,94]. Therefore, curcumin supplementation has a positive effect on the inflammatory and regenerative response in tendinopathies. However, tendinopathy, which involves degeneration or damage to a tendon, typically does not directly progress to osteoarthritis. Nevertheless, both conditions can occur simultaneously, especially in weight-bearing joints such as the knees, due to similar risk factors like overuse, aging, or injury. Tendinopathy affects tendons, while osteoarthritis affects joint cartilage. Chronic tendon damage may contribute to joint instability, potentially worsening or contributing to the development of osteoarthritis, but they remain distinct conditions. While tendinopathy does not directly evolve into osteoarthritis, reducing chronic tendon damage could help maintain joint stability, which might indirectly slow the progression of osteoarthritis, particularly in weight-bearing joints like the knee. Therefore, curcumin reduces pain and improves joint function in damaged tendons, reducing the risk of knee osteoarthritis [95]. This supplement could be an optimal candidate to test in female soccer players in future research.

4.4. Plant Extracts

Phytochemicals present in plant extracts are rich in polyphenols that display antioxidant and anti-inflammatory actions. These compounds are instrumental in post-exercise recovery, which is essential to prevent joint injuries for optimal subsequent performance [96]. Plant extracts are very popular in oriental medicine, providing a large variety of phytochemicals, including polyphenols, terpenes, and alkaloids. These herbal formulations have been assayed during different periods of time (2–32 weeks) and with different doses [97]. Due to this variability, it is not possible to reach clear recommendations for knee osteoarthritis prevention or treatment. Nevertheless, some points should be considered. Herbal extracts were effective in moderately reducing joint stiffness [97]. However, these supplements seem to be less effective when compared to well-stablished active medicines, such as nonsteroidal anti-inflammatory drugs. On the other hand, due to the huge variety of compounds present in these formulations, it is difficult to decipher the molecular mechanisms involved and which particular compounds or possible interactions exert the described effects [97]. Nevertheless, these supplements are safe and do not present side effects, only sporadic gastrointestinal problems have been noticed [97]. Nevertheless, due to huge variability of compounds and the modest effects presented in this systematic review [97], these nutraceuticals are not first candidates to test in future research on knee osteoarthritis in female soccer players.

4.5. Vitamin D

Vitamin D is considered to act directly on collagen synthesis. In vitro experiments confirmed that vitamin D added to human fibroblast cultures increases COL-I (collagen type 1) mRNA levels, together with a decrease in ROS (reactive oxygen species) and matrix metalloproteinases expression. Furthermore, experiments in animal models deficient in vitamin D present cartilage disorganization and weakness [98]. Therefore, a positive correlation exists between vitamin D levels and the strength of tendon healing [99]. However, very few studies used vitamin D to treat osteoarthritis. The studies were carried out at long term (1–2 years) with daily doses ranging from 2000 to 3000 IU. Vitamin D significantly decreased pain and improved joint function, but with modest results [89]. Considering the published evidence analyzed in this systematic review [89], vitamin D does not seem to be a candidate supplement to test in the treatment of knee osteoarthritis in female soccer players. However, this evidence demonstrates that vitamin D has a positive effect on tendon tissue, supporting positive actions in bone health. Therefore, vitamin D deficiency could be a limiting factor for collagen synthesis. In this line, vitamin D could be a protective agent in preventing joint injuries that initiate osteoarthritis [100,101]. Therefore, more research is necessary to reach consistent conclusions.

4.6. Chondroitin and Glucosamine

Proteoglycan is an essential component in the cartilaginous matrix. Individuals with osteoarthritis present reduced sulfate in cartilage tissue, resulting in low proteoglycan biosynthesis. Chondroitin and glucosamine provide cartilage cells with sulfate groups for proteoglycan biosynthesis. Acetylated glucosamine is an essential constituent of the glycosaminoglycans, part of proteoglycan structure together with collagen in articular cartilage. In vitro studies seem to suggest a cartilage-repairing effect of glucosamine. However, intervention studies conducted with various formulations and doses have yielded inconclusive results [102]. The only positive results have been obtained by combining glucosamine with chondroitin, but studies are still scarce [103]. Modest pain reduction and recovery of joint function have been documented. Therefore, there is not enough evidence to recommend glucosamine for osteoarthritis treatment in female soccer players. Additional evidence in future intervention studies is necessary to present chondroitin plus glucosamine as candidate nutraceuticals to treat knee osteoarthritis in female soccer players.

4.7. Collagen

Collagen molecules are arranged in fibers specially designed to transmit forces between muscle and bone. Therefore, hydrolyzed collagen could be a candidate for a supplement in knee osteoarthritis. However, undenatured collagen type II (UC-II) retains its natural three-dimensional structure, allowing it to interact more effectively with the immune system and trigger a tolerance response reducing inflammation. For this reason, UC-II seems to be a very promising nutraceutical in knee osteoarthritis treatment. UC-II can reduce pain, stiffness, and improve quality of life, according to one intervention carried out in individuals with knee osteoarthritis, aged of 60–80 years, treated for 3 months [104]. UC-II is obtained from chicken sternum, using a patented process at low temperature to preserve the native structure. Type II collagen is the main component present in cartilage. The mechanism of action of UC-II is suggested to be the restoration of joint collagen, through a process of desensitization of the immune system and recovery of joint integrity and mobility [105]. Thus, in healthy subjects, supplementation with UC-II prolongs the period of strenuous effort without pain and relieves joint pain that occasionally appears in such activities [106]. Furthermore, daily supplementation with 40 mg of UC-II was well tolerated and improved knee joint extension in healthy subjects [107]. In a health context, small doses of UC-II have been administered for the treatment of rheumatoid arthritis [105,108,109]. In this line, significant improvements were also observed in subjects affected by osteoarthritis after 180 days of treatment with UC-II, compared to placebo [107]. Additionally, UC-II consumption significantly reduced circulating levels of inflammatory cytokines, which could decrease both the incidence and severity of arthritis [110,111]. Altogether, this implies an improvement in the quality of life of people affected with osteoarthritis [108,109]. All this evidence supports the use of UC-II as a candidate supplement for knee osteoarthritis treatment in female soccer players.

5. Limitation

Finally, the main limitation of this narrative review is the lack of literature on this topic. Searching with keywords (KNEE OSTEOARTHRITIS and FEMALE SOCCER PLAYERS and NUTRACEUTICLAS) in databases, such as PubMed, indicated “No results were found”. Therefore, this is the main reason for performing a narrative review instead of a systematic or scoping review. Nevertheless, the proposed supplements are supported by key systematic reviews [83,89,95,97]. Therefore, the main practical implication would be to plan an intervention with female soccer players affected by knee osteoarthritis, using individual supplements or a combination of them in the context of an optimal diet. According to this review, the primary candidates for testing in future research are omega-3 fatty acids or curcumin in combination with UC-II. Soccer is one of the most widely practiced and highly mediatic sport. For this reason, the incidence of injuries associated with the game’s dynamics should be an active area of research.

6. Conclusions

Although some nutraceuticals like omega-3 fatty acids and curcumin have shown positive effects in reducing pain and improving joint function in patients, the overall evidence on the effectiveness of these supplements for knee osteoarthritis is limited. On the other hand, the mixed results observed in clinical studies, particularly with glucosamine, suggest that these products cannot be conclusively recommended for the treatment of osteoarthritis. Further high-quality research is needed to determine the exact role of diet supplements in managing this condition. On the other hand, supplementation with UC-II may be considered to implement osteoarthritis treatments and restore joint function in soccer players, particularly females. Therefore, we hope that the present narrative review could motivate research groups to address this, and other questions related to knee osteoarthritis.
The main conclusion is that the candidate supplements with the most solid scientific evidence for the treatment of knee osteoarthritis are curcumin, omega-3 fatty acids to control inflammation, and UC-II to repair tissue damage. These nutraceuticals should be tested in the context of a diet adapted to soccer demands.

Author Contributions

Conceptualization, A.C.-G. and E.R.; methodology, D.C.N.-G.; resources, A.C.-G.; writing—original draft preparation, A.C.-G. and E.R.; writing—review and editing, A.C.-G. and E.R.; supervision, A.C.-G. and A.C.-C.; project administration, A.C.-G.; funding acquisition, A.C.-G. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Acknowledgments

We acknowledge the support of Caja Rural Soria. CIBEROBN is an initiative of Instituto de Salud Carlos III (Spain). To Alfredo Cordova in memoriam.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Blanco-García, F.J.; Hernández-Royo, A.; Trigueros, J.A.; Gimeno-Marqués, A.; Fernández-Portal, L.; Badia-Llach, X. Guía de Práctica Clínica en Artrosis de Rodilla; You & US: Madrid, Spain, 2003. [Google Scholar]
  2. Hunter, D.J.; Felson, D.T. Osteoarthritis. BMJ 2006, 332, 639–642. [Google Scholar] [CrossRef]
  3. Blanco, F.J.; Silva-Díaz, M.; Quevedo-Vila, V.; Seoane-Mato, D.; Pérez-Ruiz, F.; Juan-Mas, A.; Pego-Reigosa, J.M.; Narváez, J.; Quilis, N.; Cortés, R.; et al. EPISER2016 Project Working Group. Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study. Reumatol. Clin. 2021, 17, 461–470. [Google Scholar] [CrossRef]
  4. Spahn, G.; Schiele, R.; Hofmann, G.O.; Schiltenwolf, M.; Grifka, J.; Vaitl, T.; Schneider, S.; Liebers, F.; Klinger, H.M. Die Prävalenz der radiologischen Gonarthrose in Bezug zu Lebensalter, Geschlecht, Jahrgangskohorte und ethnischer Zugehörigkeit. Eine Metaanalyse [The prevalence of radiological osteoarthritis in relation to age, gender, birth-year cohort, and ethnic origins]. Z. Orthopädie Unfallchirurgie 2011, 149, 145–152. [Google Scholar] [CrossRef]
  5. Woolf, A.D.; Pfleger, B. Burden of major musculoskeletal conditions. Bull. World Health Organ. 2003, 81, 646–656. [Google Scholar] [PubMed]
  6. Guermazi, A.; Niu, J.; Hayashi, D.; Roemer, F.W.; Englund, M.; Neogi, T.; Aliabadi, P.; McLennan, C.E.; Felson, D.T. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: Population based observational study (Framingham Osteoarthritis Study). BMJ 2012, 345, e5339. [Google Scholar] [CrossRef] [PubMed]
  7. Courties, A.; Kouki, I.; Soliman, N.; Mathieu, S.; Sellam, J. Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthr. Cartil. 2024, 32, 1397–1404. [Google Scholar] [CrossRef] [PubMed]
  8. Steinwachs, M.R.; Engebretsen, L.; Brophy, R.H. Scientific Evidence Base for Cartilage Injury and Repair in the Athlete. Cartilage 2012, 3, 11S–17S. [Google Scholar] [CrossRef]
  9. Heidari, B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Casp. J. Intern. Med. 2011, 2, 205–212. [Google Scholar]
  10. Ostenberg, A.; Roos, H. Injury risk factors in female European football. A prospective study of 123 players during one season. Scand. J. Med. Sci. Sports 2000, 10, 279–285. [Google Scholar] [CrossRef] [PubMed]
  11. Noriega-González, D.; Caballero-García, A.; Roche, E.; Álvarez-Mon, M.; Córdova, A. Inflammatory Process on Knee Osteoarthritis in Cyclists. J. Clin. Med. 2023, 12, 3703. [Google Scholar] [CrossRef] [PubMed]
  12. Driban, J.B.; Hootman, J.M.; Sitler, M.R.; Harris, K.P.; Cattano, N.M. Is Participation in Certain Sports Associated with Knee Osteoarthritis? A Systematic Review. J. Athl. Train. 2017, 52, 497–506. [Google Scholar] [CrossRef]
  13. Nehrer, S.; Neubauer, M.; Stotter, C. Osteoarthritis and/or sports. Dtsch. Z. Sportmed. 2019, 70, 169–174. [Google Scholar] [CrossRef]
  14. Jakobsen, J.R.; Krogsgaard, M.R. The Myotendinous Junction-A Vulnerable Companion in Sports. A Narrative Review. Front. Physiol. 2021, 12, 635561. [Google Scholar] [CrossRef] [PubMed]
  15. Palazzo, C.; Nguyen, C.; Lefevre-Colau, M.M.; Rannou, F.; Poiraudeau, S. Risk factors and burden of osteoarthritis. Ann. Phys. Rehabil. Med. 2016, 59, 134–138. [Google Scholar] [CrossRef]
  16. Wluka, A.E.; Lombard, C.B.; Cicuttini, F.M. Tackling obesity in knee osteoarthritis. Nat. Rev. Rheumatol. 2013, 9, 225–235. [Google Scholar] [CrossRef] [PubMed]
  17. Silverwood, V.; Blagojevic-Bucknall, M.; Jinks, C.; Jordan, J.L.; Protheroe, J.; Jordan, K.P. Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthr. Cartil. 2015, 23, 507–515. [Google Scholar] [CrossRef]
  18. Kulkarni, K.; Karssiens, T.; Kumar, V.; Pandit, H. Obesity and osteoarthritis. Maturitas 2016, 89, 22–28. [Google Scholar] [CrossRef] [PubMed]
  19. Musumeci, G.; Aiello, F.C.; Szychlinska, M.A.; Di Rosa, M.; Castrogiovanni, P.; Mobasheri, A. Osteoarthritis in the XXIst century: Risk factors and behaviours that influence disease onset and progression. Int. J. Mol. Sci. 2015, 16, 6093–6112. [Google Scholar] [CrossRef] [PubMed]
  20. López-Valenciano, A.; Ruiz-Pérez, I.; Garcia-Gómez, A.; Vera-Garcia, F.J.; De Ste Croix, M.; Myer, G.D.; Ayala, F. Epidemiology of injuries in professional football: A systematic review and meta-analysis. Br. J. Sports Med. 2020, 54, 711–718. [Google Scholar] [CrossRef]
  21. Madry, H.; Kon, E.; Condello, V.; Peretti, G.M.; Steinwachs, M.; Seil, R.; Berruto, M.; Engebretsen, L.; Filardo, G.; Angele, P. Early osteoarthritis of the knee. Knee Surg. Sports Traumatol. Arthrosc. 2016, 24, 1753–1762. [Google Scholar] [CrossRef] [PubMed]
  22. Reginster, J.Y.; Pelletier, J.P.; Martel-Pelletier, J.; Henrotin, Y. Osteoarthritis: Clinical and Experimental Aspects; Springer: Berlin, Germany, 1999. [Google Scholar]
  23. Xu, L.; Polur, I.; Servais, J.M.; Hsieh, S.; Lee, P.L.; Goldring, M.B.; Li, Y. Intact pericellular matrix of articular cartilage is required for unactivated discoidin domain receptor 2 in the mouse model. Am. J. Pathol. 2011, 179, 1338–1346. [Google Scholar] [CrossRef]
  24. Sakata, R.; McNary, S.M.; Miyatake, K.; Lee, C.A.; Van den Bogaerde, J.M.; Marder, R.A.; Reddi, A.H. Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma. Am. J. Sports Med. 2015, 43, 1467–1473. [Google Scholar] [CrossRef] [PubMed]
  25. Neu, C.P.; Reddi, A.H.; Komvopoulos, K.; Schmid, T.M.; Di Cesare, P.E. Increased friction coefficient and superficial zone protein expression in patients with advanced osteoarthritis. Arthritis Rheum. 2010, 62, 2680–2687. [Google Scholar] [CrossRef] [PubMed]
  26. Desrochers, J.; Amrein, M.W.; Matyas, J.R. Microscale surface friction of articular cartilage in early osteoarthritis. J. Mech. Behav. Biomed. Mater. 2013, 25, 11–22. [Google Scholar] [CrossRef]
  27. Scanzello, C.R.; Goldring, S.R. The role of synovitis in osteoarthritis pathogenesis. Bone 2012, 51, 249–257. [Google Scholar] [CrossRef]
  28. Goldring, M.B.; Berenbaum, F. Emerging targets in osteoarthritis therapy. Curr. Opin. Pharmacol. 2015, 22, 51–63. [Google Scholar] [CrossRef]
  29. Goldring, M.B.; Marcu, K.B. Cartilage homeostasis in health and rheumatic diseases. Arthritis Res. Ther. 2009, 11, 224. [Google Scholar] [CrossRef] [PubMed]
  30. Kapoor, M.; Martel-Pelletier, J.; Lajeunesse, D.; Pelletier, J.P.; Fahmi, H. Role of proinflammatory cytokines in the pathophysiology of osteoarthritis. Nat. Rev. Rheumatol. 2011, 7, 33–42. [Google Scholar] [CrossRef] [PubMed]
  31. Brouwer, G.M.; van Tol, A.W.; Bergink, A.P.; Belo, J.N.; Bernsen, R.M.; Reijman, M.; Pols, H.A.; Bierma-Zeinstra, S.M. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007, 56, 1204–1211. [Google Scholar] [CrossRef] [PubMed]
  32. Sharma, L.; Song, J.; Felson, D.T.; Cahue, S.; Shamiyeh, E.; Dunlop, D.D. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001, 286, 188–195. [Google Scholar] [CrossRef] [PubMed]
  33. Katz, J.N.; Arant, K.R.; Loeser, R.F. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA 2021, 325, 568–578. [Google Scholar] [CrossRef] [PubMed]
  34. Felson, D.T.; McLaughlin, S.; Goggins, J.; LaValley, M.P.; Gale, M.E.; Totterman, S.; Li, W.; Hill, C.; Gale, D. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann. Intern. Med. 2003, 139, 330–336. [Google Scholar] [CrossRef]
  35. Taljanovic, M.S.; Graham, A.R.; Benjamin, J.B.; Gmitro, A.F.; Krupinski, E.A.; Schwartz, S.A.; Hunter, T.B.; Resnick, D.L. Bone marrow edema pattern in advanced hip osteoarthritis: Quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology. Skelet. Radiol. 2008, 37, 423–431. [Google Scholar] [CrossRef]
  36. Maneiro, E.; Martín, M.A.; de Andres, M.C.; López-Armada, M.J.; Fernández-Sueiro, J.L.; del Hoyo, P.; Galdo, F.; Arenas, J.; Blanco, F.J. Mitochondrial respiratory activity is altered in osteoarthritic human articular chondrocytes. Arthritis Rheum. 2003, 48, 700–708. [Google Scholar] [CrossRef] [PubMed]
  37. Molnar, V.; Matišić, V.; Kodvanj, I.; Bjelica, R.; Jeleč, Ž.; Hudetz, D.; Rod, E.; Čukelj, F.; Vrdoljak, T.; Vidović, D.; et al. Cytokines and Chemokines Involved in Osteoarthritis Pathogenesis. Int. J. Mol. Sci. 2021, 22, 9208. [Google Scholar] [CrossRef] [PubMed]
  38. Scanzello, C.R. Chemokines and inflammation in osteoarthritis: Insights from patients and animal models. J. Orthop. Res. 2017, 35, 735–739. [Google Scholar] [CrossRef] [PubMed]
  39. Roos, E.M.; Arden, N.K. Strategies for the prevention of knee osteoarthritis. Nat. Rev. Rheumatol. 2016, 12, 92–101. [Google Scholar] [CrossRef]
  40. van Mechelen, W.; Hlobil, H.; Kemper, H.C. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med. 1992, 14, 82–99. [Google Scholar] [CrossRef]
  41. Kujala, U.M.; Kettunen, J.; Paananen, H.; Aalto, T.; Battié, M.C.; Impivaara, O.; Videman, T.; Sarna, S. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. 1995, 38, 539–546. [Google Scholar] [CrossRef] [PubMed]
  42. Roos, H.; Laurén, M.; Adalberth, T.; Roos, E.M.; Jonsson, K.; Lohmander, L.S. Knee osteoarthritis after meniscectomy: Prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998, 41, 687–693. [Google Scholar] [CrossRef] [PubMed]
  43. Gelber, A.C.; Hochberg, M.C.; Mead, L.A.; Wang, N.Y.; Wigley, F.M.; Klag, M.J. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann. Intern. Med. 2000, 133, 321–328. [Google Scholar] [CrossRef]
  44. Lohmander, L.S.; Englund, P.M.; Dahl, L.L.; Roos, E.M. The long-term consequence of anterior cruciate ligament and meniscus injuries: Osteoarthritis. Am. J. Sports Med. 2007, 35, 1756–1769. [Google Scholar] [CrossRef] [PubMed]
  45. Malfait, A.M.; Schnitzer, T.J. Towards a mechanism-based approach to pain management in osteoarthritis. Nat. Rev. Rheumatol. 2013, 9, 654–664. [Google Scholar] [CrossRef] [PubMed]
  46. Sanchis-Alfonso, V.; Rosello-Sastre, E.; Martinez-Sanjuan, V. Pathogenesis of anterior knee pain syndrome and functional patellofemoral instability in the active young. Am. J. Knee Surg. 1999, 12, 29–40. [Google Scholar]
  47. Bradley, P.S.; Di Mascio, M.; Peart, D.; Olsen, P.; Sheldon, B. High-intensity activity profiles of elite soccer players at different performance levels. J. Strength Cond. Res. 2010, 24, 2343–2351. [Google Scholar] [CrossRef] [PubMed]
  48. Kabacinski, J.; Szozda, P.M.; Mackala, K.; Murawa, M.; Rzepnicka, A.; Szewczyk, P.; Dworak, L.B. Relationship between Isokinetic Knee Strength and Speed, Agility, and Explosive Power in Elite Soccer Players. Int. J. Environ. Res. Public Health 2022, 19, 671. [Google Scholar] [CrossRef]
  49. Stepinski, M.; Ceylan, H.I.; Zwierko, T. Seasonal variation of speed, agility and power performance in elite female soccer players: Effect of functional fitness. Phys. Act. Rev. 2020, 8, 16–25. [Google Scholar] [CrossRef]
  50. Krustrup, P.; Zebis, M.; Jensen, J.M.; Mohr, M. Game-induced fatigue patterns in elite female soccer. J. Strength Cond. Res. 2010, 24, 437–441. [Google Scholar] [CrossRef] [PubMed]
  51. von Porat, A.; Roos, E.M.; Roos, H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: A study of radiographic and patient relevant outcomes. Ann. Rheum. Dis. 2004, 63, 269–273. [Google Scholar] [CrossRef] [PubMed]
  52. Hawkins, R.D.; Hulse, M.A.; Wilkinson, C.; Hodson, A.; Gibson, M. The association football medical research programme: An audit of injuries in professional football. Br. J. Sports Med. 2001, 35, 43–47. [Google Scholar] [CrossRef]
  53. Junge, A.; Dvorak, J. Soccer injuries: A review on incidence and prevention. Sports Med. 2004, 34, 929–938. [Google Scholar] [CrossRef]
  54. Roth, T.S.; Osbahr, D.C. Knee Injuries in Elite Level Soccer Players. Am. J. Orthop. 2018, 47, 10.12788–ajo.2018. [Google Scholar] [CrossRef]
  55. Wong, P.; Hong, Y. Soccer injury in the lower extremities. Br. J. Sports Med. 2005, 39, 473–482. [Google Scholar] [CrossRef] [PubMed]
  56. Freiberg, A.; Bolm-Audorff, U.; Seidler, A. The Risk of Knee Osteoarthritis in Professional Soccer Players—A Systematic Review with Meta-Analyses. Dtsch. Arztebl. Int. 2021, 118, 49–55. [Google Scholar] [CrossRef] [PubMed]
  57. Faude, O.; Junge, A.; Kindermann, W.; Dvorak, J. Injuries in female soccer players: A prospective study in the German national league. Am. J. Sports Med. 2005, 33, 1694–1700. [Google Scholar] [CrossRef] [PubMed]
  58. Engström, B.; Johansson, C.; Törnkvist, H. Soccer injuries among elite female players. Am. J. Sports Med. 1991, 19, 372–375. [Google Scholar] [CrossRef]
  59. Söderman, K.; Adolphson, J.; Lorentzon, R.; Alfredson, H. Injuries in adolescent female players in European football: A prospective study over one outdoor soccer season. Scand. J. Med. Sci. Sports 2001, 11, 299–304. [Google Scholar] [CrossRef]
  60. Sullivan, J.A.; Gross, R.H.; Grana, W.A.; Garcia-Moral, C.A. Evaluation of injuries in youth soccer. Am. J. Sports Med. 1980, 8, 325–327. [Google Scholar] [CrossRef]
  61. Del Coso, J.; Rodas, G.; Buil, M.Á.; Sánchez-Sánchez, J.; López, P.; González-Ródenas, J.; Gasulla-Anglés, P.; López-Samanes, Á.; Hernández-Sánchez, S.; Iztueta, A.; et al. Association of the ACTN3 rs1815739 Polymorphism with Physical Performance and Injury Incidence in Professional Women Football Players. Genes 2022, 13, 1635. [Google Scholar] [CrossRef] [PubMed]
  62. Joo, C.H. Epidemiology of soccer injuries in Korea women national team for 5 years. J. Exerc. Rehabil. 2022, 18, 68–73. [Google Scholar] [CrossRef] [PubMed]
  63. Xiao, M.; Nguyen, J.N.; Hwang, C.E.; Abrams, G.D. Increased Lower Extremity Injury Risk Associated With Player Load and Distance in Collegiate Women’s Soccer. Orthop. J. Sports Med. 2021, 9, 23259671211048248. [Google Scholar] [CrossRef]
  64. Meeuwisse, W.H.; Tyreman, H.; Hagel, B.; Emery, C. A dynamic model of etiology in sport injury: The recursive nature of risk and causation. Clin. J. Sport. Med. 2007, 17, 215–219. [Google Scholar] [CrossRef] [PubMed]
  65. Taimela, S.; Osterman, L.; Kujala, U.; Lehto, M.; Korhonen, T.; Alaranta, H. Motor ability and personality with reference to soccer injuries. J. Sports Med. Phys. Fit. 1990, 30, 194–201. [Google Scholar]
  66. Watson, A.W. Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of body contact sports. Int. J. Sports Med. 2001, 22, 222–225. [Google Scholar] [CrossRef]
  67. Roos, H.; Lindberg, H.; Gärdsell, P.; Lohmander, L.S.; Wingstrand, H. The prevalence of gonarthrosis and its relation to meniscectomy in former soccer players. Am. J. Sports Med. 1994, 22, 219–222. [Google Scholar] [CrossRef]
  68. Roos, H.; Ornell, M.; Gärdsell, P.; Lohmander, L.S.; Lindstrand, A. Soccer after anterior cruciate ligament injury--an incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players. Acta Orthop. Scand. 1995, 66, 107–112. [Google Scholar] [CrossRef] [PubMed]
  69. Söderman, K.; Alfredson, H.; Pietilä, T.; Werner, S. Risk factors for leg injuries in female soccer players: A prospective investigation during one out-door season. Knee Surg. Sports Traumatol. Arthrosc. 2001, 9, 313–321. [Google Scholar] [CrossRef]
  70. Mather, R.C., 3rd; Koenig, L.; Kocher, M.S.; Dall, T.M.; Gallo, P.; Scott, D.J.; Bach, B.R., Jr.; Spindler, K.P.; MOON Knee Group. Societal and economic impact of anterior cruciate ligament tears. J. Bone Joint Surg. Am. 2013, 95, 1751–1759. [Google Scholar] [CrossRef] [PubMed]
  71. Oliveira, C.C.; Ferreira, D.; Caetano, C.; Granja, D.; Pinto, R.; Mendes, B.; Sousa, M. Nutrition and Supplementation in Soccer. Sports 2017, 5, 28. [Google Scholar] [CrossRef] [PubMed]
  72. Collins, J.; Maughan, R.J.; Gleeson, M.; Bilsborough, J.; Jeukendrup, A.; Morton, J.P.; Phillips, S.M.; Armstrong, L.; Burke, L.M.; Close, G.L.; et al. UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research. Br. J. Sports Med. 2021, 55, 416. [Google Scholar] [CrossRef] [PubMed]
  73. de Sousa, M.V.; Lundsgaard, A.M.; Christensen, P.M.; Christensen, L.; Randers, M.B.; Mohr, M.; Nybo, L.; Kiens, B.; Fritzen, A.M. Nutritional optimization for female elite football players-topical review. Scand. J. Med. Sci. Sports 2022, 32 (Suppl. S1), 81–104. [Google Scholar] [CrossRef]
  74. García-Rovés, P.M.; García-Zapico, P.; Patterson, A.M.; Iglesias-Gutiérrez, E. Nutrient intake and food habits of soccer players: Analyzing the correlates of eating practice. Nutrients 2014, 6, 2697–2717. [Google Scholar] [CrossRef]
  75. Keen, R. Nutrition-Related Considerations in Soccer: A Review. Am. J. Orthop. 2018, 47, 12. [Google Scholar] [CrossRef]
  76. Arden, N.K.; Perry, T.A.; Bannuru, R.R.; Bruyère, O.; Cooper, C.; Haugen, I.K.; Hochberg, M.C.; McAlindon, T.E.; Mobasheri, A.; Reginster, J.Y. Non-surgical management of knee osteoarthritis: Comparison of ESCEO and OARSI 2019 guidelines. Nat. Rev. Rheumatol. 2021, 17, 59–66. [Google Scholar] [CrossRef] [PubMed]
  77. Zeng, J.; Franklin, D.K.; Das, A.; Hirani, V. The effects of dietary patterns and food groups on symptomatic osteoarthritis: A systematic review. Nutr. Diet. 2023, 80, 21–43. [Google Scholar] [CrossRef] [PubMed]
  78. Maffulli, N.; Longo, U.G.; Denaro, V. Novel approaches for the management of tendinopathy. J. Bone Joint Surg. Am. 2010, 92, 2604–2613. [Google Scholar] [CrossRef] [PubMed]
  79. Notarnicola, A.; Moretti, L.; Baglioni, M.; Covelli, I.; Bianchi, F.P.; Citraro, A.; Moretti, B. Efficacy of Shock Waves Combined with Adjuvant Therapy with Tendon Supplement in the Treatment of Plantar Fasciitis: A Prospective Randomized Study. J. Food Nutr. Res. 2021, 9, 148–153. [Google Scholar]
  80. Notarnicola, A.; Maccagnano, G.; Tafuri, S.; Fiore, A.; Pesce, V.; Moretti, B. Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome. Int. J. Immunopathol. Pharmacol. 2015, 28, 256–262. [Google Scholar] [CrossRef] [PubMed]
  81. Aiyegbusi, A.I.; Olabiyi, O.O.; Duru, F.I.; Noronha, C.C.; Okanlawon, A.O. A comparative study of the effects of bromelain and fresh pineapple juice on the early phase of healing in acute crush achilles tendon injury. J. Med. Food 2011, 14, 348–352. [Google Scholar] [CrossRef] [PubMed]
  82. Fusini, F.; Bisicchia, S.; Bottegoni, C.; Gigante, A.; Zanchini, F.; Busilacchi, A. Nutraceutical supplement in the management of tendinopathies: A systematic review. Muscles Ligaments Tendons J. 2016, 6, 48–57. [Google Scholar] [CrossRef]
  83. Fernández-Lázaro, D.; Arribalzaga, S.; Gutiérrez-Abejón, E.; Azarbayjani, M.A.; Mielgo-Ayuso, J.; Roche, E. Omega-3 Fatty Acid Supplementation on Post-Exercise Inflammation, Muscle Damage, Oxidative Response, and Sports Performance in Physically Healthy Adults-A Systematic Review of Randomized Controlled Trials. Nutrients 2024, 16, 2044. [Google Scholar] [CrossRef] [PubMed]
  84. Lembke, P.; Capodice, J.; Hebert, K.; Swenson, T. Influence of omega-3 (n3) index on performance and wellbeing in young adults after heavy eccentric exercise. J. Sports Sci. Med. 2014, 13, 151–156. [Google Scholar] [PubMed]
  85. Tsuchiya, Y.; Yanagimoto, K.; Nakazato, K.; Hayamizu, K.; Ochi, E. Eicosapentaenoic and docosahexaenoic acids-rich fish oil supplementation attenuates strength loss and limited joint range of motion after eccentric contractions: A randomized, double-blind, placebo-controlled, parallel-group trial. Eur. J. Appl. Physiol. 2016, 116, 1179–1188. [Google Scholar] [CrossRef]
  86. Tsuchiya, Y.; Ueda, H.; Yanagimoto, K.; Kato, A.; Ochi, E. 4-week eicosapentaenoic acid-rich fish oil supplementation partially protects muscular damage following eccentric contractions. J. Int. Soc. Sports Nutr. 2021, 18, 18. [Google Scholar] [CrossRef] [PubMed]
  87. Kumar, A.; Takada, Y.; Boriek, A.M.; Aggarwal, B.B. Nuclear factor-kappaB: Its role in health and disease. J. Mol. Med. 2004, 82, 434–448. [Google Scholar] [CrossRef]
  88. Witkin, J.; Li, X. Curcumin, an Active Constiuent of the Ancient Medicinal Herb Curcuma longa L.: Some Uses and the Establishment and Biological Basis of Medical Efficacy. CNS Neurol. Disord. Drug Targets 2013, 12, 487–497. [Google Scholar] [CrossRef] [PubMed]
  89. Córdova, A.; Drobnic, F.; Noriega-González, D.; Caballero-García, A.; Roche, E.; Alvarez-Mon, M. Is Curcumine Useful in the Treatment and Prevention of the Tendinopathy and Myotendinous Junction Injury? A Scoping Review. Nutrients 2023, 15, 384. [Google Scholar] [CrossRef]
  90. Smith, R.K.W.; McIlwraith, C.W. “One Health”O in tendinopathy research: Current concepts. J. Orthop. Res. 2021, 39, 1596–1602. [Google Scholar] [CrossRef] [PubMed]
  91. Amalraj, A.; Divya, C.; Gopi, S. The Effects of Bioavailable Curcumin (Cureit) on Delayed Onset Muscle Soreness Induced By Eccentric Continuous Exercise: A Randomized, Placebo-Controlled, Double-Blind Clinical Study. J. Med. Food 2020, 23, 545–553. [Google Scholar] [CrossRef]
  92. Hillman, A.R.; Gerchman, A.; O’Hora, E. Ten Days of Curcumin Supplementation Attenuates Subjective Soreness and Maintains Muscular Power Following Plyometric Exercise. J. Diet. Suppl. 2022, 19, 303–317. [Google Scholar] [CrossRef]
  93. Dinkova-Kostova, A.T.; Talalay, P. Relation of structure of curcumin analogs to their potencies as inducers of Phase 2 detoxification enzymes. Carcinogenesis 1999, 20, 911–914. [Google Scholar] [CrossRef] [PubMed]
  94. Birznieks, I.; Burton, A.R.; Macefield, V.G. The effects of experimental muscle and skin pain on the static stretch sensitivity of human muscle spindles in relaxed leg muscles. J. Physiol. 2008, 586, 2713–2723. [Google Scholar] [CrossRef]
  95. Zeng, L.; Yang, T.; Yang, K.; Yu, G.; Li, J.; Xiang, W.; Chen, H. Efficacy and Safety of Curcumin and Curcuma longa Extract in the Treatment of Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Front. Immunol. 2022, 13, 891822. [Google Scholar] [CrossRef]
  96. Quesada-Vazquez, S.; Eseberri, I.; Les, F.; Pérez-Matute, P.; Herrnaz-López, M.; Atgié, C.; López-Yus, M.; Aranaz, P.; Oteo, J.A.; Escoté, X.; et al. Polyphenols and metabolism: From present knowledge to future challenges. J. Physiol. Biochem. 2024, 80, 603–625. [Google Scholar] [CrossRef] [PubMed]
  97. Mathieu, S.; Soubrier, M.; Peirs, C.; Monfoulet, L.E.; Boirie, Y.; Tournadre, A. A Meta-Analysis of the Impact of Nutritional Supplementation on Osteoarthritis Symptoms. Nutrients 2022, 14, 1607. [Google Scholar] [CrossRef] [PubMed]
  98. Angeline, M.E.; Ma, R.; Pascual-Garrido, C.; Voigt, C.; Deng, X.H.; Warren, R.F.; Rodeo, S.A. Effect of Diet-Induced Vitamin D Deficiency on Rotator Cuff Healing in a Rat Model. Am. J. Sports Med. 2014, 42, 27–34. [Google Scholar] [CrossRef] [PubMed]
  99. Nossov, S.; Dines, J.S.; Murrell, G.A.C.; Rodeo, S.A.; Bedi, A. Biologic augmentation of tendon-to-bone healing: Scaffolds, mechanical load, vitamin D, and diabetes. Instr. Course Lect. 2014, 63, 451–462. [Google Scholar] [PubMed]
  100. Dougherty, K.; Dilisio, M.; Agrawal, D.K. Vitamin D and the immunomodulation of rotator cuff injury. J. Inflamm. Res. 2016, 9, 123–131. [Google Scholar] [CrossRef]
  101. Poulsen, R.; Zarei, A.; Sabokbar, A.; Hulley, P. Tendon, a Vitamin D-Responsive Tissue—Why the British weather may not just be bad for your bones. Int. J. Exp. Pathol. 2013, 94, A20. [Google Scholar]
  102. Henrotin, Y.; Mobasheri, A.; Marty, M. Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis? Arthritis Res. Ther. 2012, 14, 201. [Google Scholar] [CrossRef]
  103. Meng, Z.; Liu, J.; Zhou, N. Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: A systematic review and meta-analysis. Arch. Orthop. Trauma. Surg. 2023, 143, 409–421. [Google Scholar] [CrossRef] [PubMed]
  104. Sadigursky, D.; Magnavita, V.F.S.; Sá, C.K.C.; Monteiro, H.S.; Braghiroli, O.F.M.; Matos, M.A.A. Undenatured collagen type II for the treatment of osteoarthritis of the knee. Acta Ortop. Bras. 2022, 30, e240572. [Google Scholar] [CrossRef]
  105. Bagchi, D.; Misner, B.; Bagchi, M.; Kothari, S.C.; Downs, B.W.; Fafard, R.D.; Preuss, H.G. Effects of orally administered undenatured type II collagen against arthritic inflammatory diseases: A mechanistic exploration. Int. J. Clin. Pharmacol. Res. 2002, 22, 101–110. [Google Scholar] [PubMed]
  106. Lugo, J.P.; Saiyed, Z.M.; Lau, F.C.; Molina, J.P.; Pakdaman, M.N.; Shamie, A.N.; Udani, J.K. Undenatured type II collagen (UC-II®) for joint support: A randomized, double-blind, placebo-controlled study in healthy volunteers. J. Int. Soc. Sports Nutr. 2013, 10, 48. [Google Scholar] [CrossRef] [PubMed]
  107. Lugo, J.P.; Saiyed, Z.M.; Lane, N.E. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: A multicenter randomized, double-blind, placebo-controlled study. Nutr. J. 2016, 15, 14. [Google Scholar] [CrossRef] [PubMed]
  108. Trentham, D.E.; Dynesius-Trentham, R.A.; Orav, E.J.; Combitchi, D.; Lorenzo, C.; Sewell, K.L.; Hafler, D.A.; Weiner, H.L. Effects of oral administration of type II collagen on rheumatoid arthritis. Science 1993, 261, 1727–1730. [Google Scholar] [CrossRef]
  109. Crowley, D.C.; Lau, F.C.; Sharma, P.; Evans, M.; Guthrie, N.; Bagchi, M.; Bagchi, D.; Dey, D.K.; Raychaudhuri, S.P. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: A clinical trial. Int. J. Med. Sci. 2009, 6, 312–321. [Google Scholar] [CrossRef]
  110. Tong, T.; Zhao, W.; Wu, Y.Q.; Chang, Y.; Qing-Tong, W.; Ling-Ling, Z.; Wei, W. Chicken type II collagen induced immune balance of main subtype of helper T cells in mesenteric lymphocytes in rats with collagen-induced arthritis. Inflamm. Res. 2010, 59, 369–377. [Google Scholar] [CrossRef]
  111. Nagler-Anderson, C.; Bober, L.A.; Robinson, M.E.; Siskind, G.W.; Thorbecke, G.J. Suppression of type II collagen-induced arthritis by intragastric administration of soluble type II collagen. Proc. Natl. Acad. Sci. USA 1986, 83, 7443–7446. [Google Scholar] [CrossRef] [PubMed]
Table 1. General risk factors in osteoarthritis [15,16].
Table 1. General risk factors in osteoarthritis [15,16].
GENERALRELATED TO THE JOINT
Non-modifiable
Genetics
Age
Sex
Modifiable
Overweight, obesity
Nutrition
Bone mineral density
Comorbidities		Overloading
Physical activity
Particular sports actions
Traumas
Muscle strength
Joint alignment
Joint deformity
Instability
Table 2. Particular risk factors contributing to knee osteoarthritis in sports [11,39,40,41].
Table 2. Particular risk factors contributing to knee osteoarthritis in sports [11,39,40,41].
RISK FACTORSCOMMENTS
Repetitive impactSports that involve repetitive movements and significant stress on the knee joints (i.e., soccer, basketball, running, tennis). This can accelerate the wear and tear of the joint cartilage, leading to osteoarthritis.
Previous injuriesLigament or meniscus tears, increase the risk of developing osteoarthritis even after recovery.
Joint overloadSports that require high physical exertion (i.e., weightlifting, rugby) can increase the pressure on the knees, contributing to development of knee osteoarthritis.
Duration of the sport practiceDeveloping knee osteoarthritis increases with age and the number of years spent playing a particular discipline. Therefore, high level athletes for many years are particularly susceptible.
Improper technique and equipmentImproper footwear, poor technique or inappropriate training surfaces.
Table 3. Sports disciplines with higher risk to develop knee osteoarthritis [41,42,43].
Table 3. Sports disciplines with higher risk to develop knee osteoarthritis [41,42,43].
SPORTSACTIONS FAVORING KNEE OSTEOARTHRITIS
SoccerRepetitive twisting, abrupt changes in direction, and physical contact, increased risk of ligament and meniscus injuries
BasketballFrequent jumping, landing, and quick directional changes, microtraumas to the knees
RunningLong distances, hard surfaces
WeightliftingHeavy lifting, pressure on the knee joints, improper technique
TennisQuick lateral movements and abrupt stops, starts with substantial pressure on the knees
RugbyAmerican footballHigh-intensity movements and rapid directional changes, frequent impacts and collisions
Alpine skiingRepetitive twists and turns, ligament injuries
GymnasticsRepetitive movements, landings, acrobatic maneuvers that require great control over the knee joints
Table 4. Factors contributing to a high incidence of knee osteoarthritis in women practicing sports [44,45,46].
Table 4. Factors contributing to a high incidence of knee osteoarthritis in women practicing sports [44,45,46].
FACTORCOMMENTS
AnatomyWider Q Angle (the angle between the quadriceps muscle and the patella). This angle can increase stress on the knee due to the wider pelvis that women have.
BiomechanicsWomen generally have greater joint laxity, which can make the knees less stable and more prone to ligament injuries such as anterior cruciate ligament tears, a known risk factor for osteoarthritis.
HormonesHormonal fluctuations, particularly estrogen levels, can affect cartilage integrity and ligament laxity. This is relevant after menopause.
Activity patternsDifferences in how women and men perform certain sports movements can also influence injury risk. For instance, women tend to have greater dynamic knee valgus (an inward collapse of the knees during flexion), which can increase stress on knee structures.
Table 5. Diet supplement proposals to prevent/treat knee osteoarthritis in female soccer players.
Table 5. Diet supplement proposals to prevent/treat knee osteoarthritis in female soccer players.
NUTRACEUTICALMAIN WAY OF ACTION
Omega-3 fatty acids
Curcumin		Anti-inflammatory action
Herbal extractsAntioxidants that can help reduce inflammation
Vitamin DEssential for calcium absorption necessary for bone repair
Chondroitin and glucosamineReduce pain and improve joint function
CollagenKey component of cartilage
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Caballero-García, A.; Noriega-González, D.C.; Caballero-Castillo, A.; Roche, E. Proposal for Diet Supplementation to Prevent Knee Osteoarthritis in Female Soccer Players. Dietetics 2025, 4, 8. https://doi.org/10.3390/dietetics4010008

AMA Style

Caballero-García A, Noriega-González DC, Caballero-Castillo A, Roche E. Proposal for Diet Supplementation to Prevent Knee Osteoarthritis in Female Soccer Players. Dietetics. 2025; 4(1):8. https://doi.org/10.3390/dietetics4010008

Chicago/Turabian Style

Caballero-García, Alberto, David C. Noriega-González, Aurora Caballero-Castillo, and Enrique Roche. 2025. "Proposal for Diet Supplementation to Prevent Knee Osteoarthritis in Female Soccer Players" Dietetics 4, no. 1: 8. https://doi.org/10.3390/dietetics4010008

APA Style

Caballero-García, A., Noriega-González, D. C., Caballero-Castillo, A., & Roche, E. (2025). Proposal for Diet Supplementation to Prevent Knee Osteoarthritis in Female Soccer Players. Dietetics, 4(1), 8. https://doi.org/10.3390/dietetics4010008

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