Early-onset knee osteoarthritis (OA) is no longer a condition of ageing joints; it is now an emerging threat to the careers of athletes in their prime. High-impact sports, repetitive microtrauma, and incomplete recovery after injury contribute to a biologically active and mechanically unstable joint environment, often years before radiographic changes appear. In this narrative review, we explore how modern sports medicine is shifting from reactive to proactive strategies, focusing on joint preservation, functional optimisation, and long-term performance sustainability. From precision diagnosis using advanced imaging and biomarkers to tailored exercise programmes, biologic injections, and targeted surgical options, the management of early-onset knee OA demands an integrated, sport-specific approach. The athlete’s return to sport is not merely a clinical milestone but a biomechanical, psychological, and strategic decision. Despite growing awareness, current guidelines fail to address the complexity of early-onset OA in high-performing individuals, and robust long-term data are lacking. This review provides an evidence-based framework to delay degeneration, empower athletes, and keep performance at the centre of care.
Schäfer et al. (2026) studied this question.