Objective: To establish the relation between handball playing, passive hip range of motion (ROM), and the development of radiological hip osteoarthritis (OA) in former elite handball players. Two related issues are addressed: (a) the relation between long term elite handball playing and the incidence of hip OA; (b) the relations between hip ROM, OA, and pain. Methods: Data on 20 former elite handball players and 39 control subjects were collected. A questionnaire yielded personal details, loading patterns during physical activity, and previous lower limb joint injury. Bilateral radiographs were analysed to diagnose and classify hip OA. Passive hip ROM was measured bilaterally with a goniometer. Results: A close relation was found between long term elite handball practice and the incidence of hip OA: 60% of the handball players were diagnosed with OA in at least one of the hip joints compared with 13% of the control subjects. Passive ROM measured in the handball players was significantly lower for hip flexion and medial rotation and higher for abduction, extension, and lateral rotation than the control values. The handball players with OA reported less pain in the hip joints during daily activities than the control subjects with OA. Conclusion: The risk of developing premature hip OA seems high for retired handball players and significantly greater than for the general population. Pain and discomfort represent two difficult diagnostic challenges to the sports physician, as the repetitive nature of movements that are specific to handball can lead to alterations that are rarely seen in the general population.

The aim of this paper is to review the current knowledge about degenerative and repair process of articular cartilage, and relationship between osteoarthritis and physical activities. Data Pubmed, ScienceDirect data base are interrogated for the period 1994 - 2003. Key words are: cartilage, osteoarthritis, exercise, rehabilitation. The mechanical biology of the cartilage and the chondrocytes, the effects of physical activity on the cartilage, the main studies on clinical trials on rehabilitation are reviewed. Chondrocyte and cartilage structure and function change with mechanical stresses. Mechanical loads can modulate cartilage matrix turnover. Joint injury increases the risk of osteoarthritis, and sports that subjects joints to repetitive high levels of impact loading increase the risk of injury and degeneration. In human, intensive physical exercises seem associated with osteoarthritis development. None of the current procedures for repairing articular cartilage restores a normal articular zone, however, selected procedures can predictably benefit selected subjects. This article presents the biology and discusses the alteration of cartilage as well as the osteoarthritis process which is not yet well understood. Current medical approaches to the treatment of osteoarthritis also are presented. Rehabilitation programme could be beneficial in the therapeutic management of osteoarthritis.

This preliminary clinical study has shown the advantages of this mini-invasive technique. It could not evaluate all the possible disadvantages inherent in the method. These points will be evaluated in a multicenter study justified by these preliminary results.

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