[BK 2118: knee osteoarthritis in professional football : Expert assessment of occupational exposure, sports injury, and competing causes].

BACKGROUND

German occupational disease no. 2118 covers knee osteoarthritis in female and male professional football players after at least 13 years of exposure. The disease phenotype corresponds to that of occupational disease no. 2112; exposure and individual causation are distinct.

OBJECTIVES

To develop a practical pathway separating cumulative professional football exposure from the consequences of specific ligament, meniscal, or cartilage injuries and other competing causes.

MATERIALS AND

METHODS

The statutory definition, scientific recommendation, explanatory materials, guidance for occupational disease no. 2112, systematic reviews, supplementary PubMed literature, and published case law through July 2026 were evaluated.

RESULTS

Unilateral disease, any knee compartment, and long intervals are compatible with occupational disease no. 2118 but are not diagnostic thereof. Full proof of the disease and positive individual causation are required. Contemporaneous findings, operative reports, side-to-side comparison, topography, and longitudinal course carry particular weight. Ligament rupture and total meniscectomy following occupational disease no. 2102 may constitute specific exclusions. Every partial meniscectomy requires differentiated assessment; group-level epidemiology is not an individual rule of proof.

CONCLUSIONS

An eight-step pathway integrates exposure, disease verification, injury mapping, competing causes, causation, and impairment. If essential source facts are unavailable, non-liquet must be stated.