Incidence of chronic knee lesions in long-distance runners based on training level: Findings at MRI
Introduction
Long-distance running has become a popular sport during the last several years, and the number of long-distance runners is increasing. Accordingly, the injury rate in runners, including acute injuries and overuse syndromes, has increased, especially in deconditioned or novice runners, and this has inspired several reports in the literature during these years [1], [2], [3].
However, different injury definitions used by the various authors of these studies make appropriate comparison of the study results difficult. In addition, study concepts about running distance and time span between MR examination and last training unit were divergent [4], [5]. In epidemiologic studies, musculoskeletal injuries were subjectively defined only by the runners themselves, without using magnetic resonance imaging (MRI) as a correlate [1], [2], [6].
Among the modifiable risk factors for injury rate, weekly running distance is the strongest predictor of future injuries of the lower extremity [1], [6]. Other training characteristics (speed, frequency, surface, duration) have little or no effect on musculoskeletal injuries.
A high level of sports activity, especially in sports with repetitive, high impact forces, has been considered a risk factor for chronic knee lesions that might result in osteoarthritis [7].
To our knowledge, there are few MR studies [8], [9], [10] that have evaluated the chronic impact of long-distance running on the musculoskeletal system, but none of these MR studies considered the training level of the runners.
The question prompting our investigation was whether there is a greater risk of chronic knee lesions in long-distance runners with a higher training level compared to runners with lower training level.
Section snippets
Study population
Twenty-six non-professional long-distance runners (19 men, seven women) with at least 10 years of running experience were recruited and screened to exclude subjects with a contraindication for MRI. Additional exclusion criteria were history of prior trauma, orthopedic surgery, and osteoarthritis. Informed written consent was obtained from all volunteers and the study protocol was performed with Institutional Review Board (IRB) approval.
Information on training distance per week, running
Results
In our study population, 10 runners were characterized as high-trained and 16 runners were characterized as low-trained runners.
In all subjects, 10 meniscal lesions (grade 1), and six lesions (grade 2) out of 104 meniscal horns (four meniscal horns per runner), were found. Grade 1 lesions were seen in six high-trained runners and in four low-trained runners (p = 0.63). A grade 2 meniscal lesion was observed in three high- and three low-trained runners (Fig. 2). No grade 3 or 4 meniscal lesions
Discussion
Many studies have investigated the injury rate associated with running, reporting various rates between 25–65% [2], [3], [22], [23]. In the literature, knee problems and injuries of the ankle, and foot are described as the most common injuries in both male and female runners [24], [25].
In our study, with a special focus on the training level of the runners, we evaluated chronic injuries of the knee with MR imaging, which is an established excellent diagnostic tool for the imaging of soft tissue
Acknowledgment
We acknowledge Michael Weber, Department of Radiology, Medical University of Vienna, Austria, for his assistance in statistical evaluation.
References (41)
- et al.
The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture
Arthroscopy
(2004) - et al.
Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?
J Clin Epidemiol
(2000) - et al.
The causes and mechanisms of meniscal injuries in the sporting and non-sporting environment in an unselected population
Knee
(2004) - et al.
Factors affecting progression of knee cartilage defects in normal subjects over 2 years
Rheumatology (Oxford)
(2005) Lower extremity injuries in runners. Advances in prediction
Sports Med
(1992)- et al.
Predicting lower-extremity injuries among habitual runners
Arch Int Med
(1989) Running injuries. A review of the epidemiological literature
Sports Med
(1992)- et al.
Change in knee cartilage T2 at MR imaging after running: a feasibility study
Radiology
(2005) - et al.
Jogging causes acute changes in the knee joint: an MR study in normal volunteers
AJR
(1990) - et al.
Predictors of lower extremity injury among recreationally active adults
Clin J Sport Med
(2002)
Update on osteoarthritis part 1: current concepts and the relation to exercise
Br J Sports Med
MR imaging of the hip and knee before and after marathon running
Am J Sports Med
Knees of trained long-distance runners: MR imaging before and after competition
Radiology
MR imaging of the knee in marathon runners before and after competition
Skeletal Radiol
The meniscus: recent advances in MR imaging of the knee
AJR
MRI of the cartilage
Eur Radiol
Magnetic resonance imaging of articular cartilage and evaluation of cartilage disease
Invest Radiol
Meniscal tears: pathologic correlation with MR imaging
Radiology
Cited by (38)
MRI study of changes in knee bone marrow edema-like signal in asymptomatic amateur marathon runners before and after half-marathon running
2021, Clinical ImagingCitation Excerpt :The total incidence of knee bone marrow edema-like signal in amateur marathon runners in this study was 62% (31/50 subjects), of which grade 1, 2 and 3 was 48% (24/50 subjects), 12% (6/50 subjects) and 2% (1/50 subjects), respectively. Previous studies3,8 showed that the incidence of knee bone marrow edema-like signals in asymptomatic marathon runners ranged from 10% ~ 62.5%. Kornaat et al.5 found that almost all asymptomatic professional long-distance runners (88%,14/16) showed bone marrow edema-like signal lesions before the race.
Assessing the effect of football play on knee articular cartilage using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC)
2017, Magnetic Resonance ImagingCitation Excerpt :Since football players place higher demand on their knees, articular cartilage injuries occur in practice and game play, and the injury rate per game is increased over time. The mean body mass index (BMI) among football players (31 kg/m2) [5] is higher than in other athlete groups (21 kg/m2) in the review [23–25]. Per position, linemen were found to have the highest incidence (37%), with over 54% of the lesions being on the femoral condyles.
Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma
2016, Revista Brasileira de OrtopediaBiochemical cartilage alteration and unexpected signal recovery in T2* mapping observed in ankle joints with mobile MRI during a transcontinental multistage footrace over 4486km
2014, Osteoarthritis and CartilageCitation Excerpt :There is abundant research on consequences of obesity and sedentary lifestyles for the human body and lower extremity joints in particular1. Little or contradictory information is available about the impact of high levels of endurance running exercise on the joints of the legs2,3. The 4486 km long ultramarathon TransEurope FootRace (TEFR)4 where the participants were continuously monitored using a mobile magnetic resonance imaging (MRI) traveling along on a semitrailer truck offered a unique, once in a life time opportunity for investigating the physiological responses to extreme contiguous 64 day exercise without any day of rest.
Gradual strenuous running regimen predisposes to osteoarthritis due to cartilage cell death and altered levels of glycosaminoglycans
2013, Osteoarthritis and CartilageCitation Excerpt :The question that still remains in the literature concerns excessive exercise or strenuous running and its consequences for the cartilage. Contradictory studies show absence14,25 or presence12,26–28 of relationship between strenuous exercise or higher physical activity levels and osteoarthritis. Our results demonstrated a significant decrease of GAG content in the articular cartilage and increased cell death and inflammation after heavy exercise.
Quality of life during the wait for ruptured anterior cruciate ligament reconstruction: a randomized controlled trial
2022, Canadian Journal of Surgery