Incidence of chronic knee lesions in long-distance runners based on training level: Findings at MRI

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Abstract

Purpose

The purpose of this study was to evaluate the incidence of chronic knee changes in long-distance runners based on the training status, including distance, running frequency, training pace, and running experience.

Methods

MRI of the knee was performed in 26 non-professional runners 5 days after their last training unit. Lesions of the menisci and cartilage (5-point scale), bone marrow and ligaments (3-point scale), and joint effusion were evaluated. A total score comprising all knee lesions in each runner was evaluated. The incidence of the knee changes was correlated with the training level, gender, and age of the runners.

Results

Grade 1 lesions of the menisci were found in six runners with a high training level, and in only four runners with a low training level. Grade 1 cartilage lesions were found in three high-trained runners and in one low-trained runner, and grade 2 lesions were found in one high-trained runner and in two low-trained runners, respectively. Grade 1 anterior cruciate ligament lesions were seen in three runners with a high- and in two runners with a low-training level. Runners with a higher training level showed a statistically significant higher score for all chronic knee lesions than those with a lower training level (p < 0.05).

Conclusions

MRI findings indicate that a higher training level in long-distance runners is a risk factor for chronic knee lesions.

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.

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