Background: Professional soccer players are exposed to considerable impact on the knee during growth that may affect bone morphology and accessory ossicles.
Purpose: To identify differences in knee bone morphology, including accessory ossicle development, between soccer players and controls.
Study design: Cross-sectional study; Level of evidence, 3.
Methods: The soccer group included male professional soccer players (n = 334 knees) who had medical checkups at the authors' hospital from 2013 to 2023. Controls were male, age-matched patients at the same hospital (n = 223 knees). Knee radiographs (bilateral anteroposterior, lateral, and sky-line views) were obtained from patients. Each radiograph was evaluated to determine the Insall-Salvati ratio, tuberosity height ratio (THR), posterior tibial slope (PTS), ossicles associated with Osgood-Schlatter disease (OOSDs), Sinding-Larsen-Johansson disease, and bipartite patella (BP).
Results: The soccer group had a significantly higher THR (0.276), PTS (9.42°), and incidences of OOSD (10.8%) and BP (6.3%) than the control group (0.213, 8.23°, 3.1%, and 0.45%, respectively) (P < .001, P < .001, P = .002, and P = .001, respectively). In the soccer group, THR and PTS were significantly higher on the dominant side (0.289 and 9.84°, respectively) than on the nondominant side (0.269 and 9.0°, respectively) (P = .049 and P = .009, respectively).
Conclusion: Elite male soccer players had a larger prominence on the tibial tuberosity, steeper PTS, and higher OOSD and BP incidence. Additionally, they had greater tibial tuberosity prominence and PTS on the dominant side. These findings suggest that repetitive mechanical loading during growth may influence knee bone morphology.
Keywords: Osgood-Schlatter disease; knee bone morphology; posterior tibial slope; radiological assessment; soccer.
© The Author(s) 2025.