Skip to main content
Log in

The effect of a six-month training program followed by a marathon run on knee joint cartilage volume and thickness in marathon beginners

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to investigate the effect of a 6-month period of intensive running followed by the participation at a marathon run on cartilage volume and thickness in knees of marathon beginners.

Methods

Ten asymptomatic marathon beginners underwent a supervised 6-month training program, which was finalized by the participation at a marathon run. Three-dimensional quantitative magnetic resonance imaging was performed before the training program (baseline measurements) and 1 day after the marathon (follow-up measurements). Cartilage volume and thickness of the medial and lateral femur, medial and lateral tibia, and patella were measured using semiautomated cartilage segmentation and three dimensional data postprocessing.

Results

Significant differences between baseline and follow-up measurements were observed at the lateral femur, where cartilage volume and thickness decreased by a mean of 3.2 ± 3.0 % (p = 0.012) and 1.7 ± 1.6 % (p = 0.010), respectively. No significant changes in cartilage volume and thickness were observed at the medial and lateral tibia, the medial femur, and the patella.

Conclusion

Significant cartilage loss was observed at the lateral femur; however, the measured values are comparable to previously reported precision errors for quantitative cartilage measurement and thus most likely not of clinical relevance. High-impact forces during long-distance running are well tolerated even in marathon beginners and do not lead to clinical relevant cartilage loss.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Boocock M, McNair P, Cicuttini F, Stuart A, Sinclair T (2009) The short-term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee. Osteoarthr Cartil 17(7):883–890

    Article  CAS  PubMed  Google Scholar 

  2. Burgkart R, Glaser C, Hinterwimmer S, Hudelmaier M, Englmeier KH, Reiser M, Eckstein F (2003) Feasibility of T and Z scores from magnetic resonance imaging data for quantification of cartilage loss in osteoarthritis. Arthritis Rheum 48(10):2829–2835

    Article  CAS  PubMed  Google Scholar 

  3. Burgkart R, Glaser C, Hyhlik-Durr A, Englmeier KH, Reiser M, Eckstein F (2001) Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value. Arthritis Rheum 44(9):2072–2077

    Article  CAS  PubMed  Google Scholar 

  4. Caselli MA, Longobardi SJ (1997) Lower extremity injuries at the New York City Marathon. J Am Podiatr Med Assoc 87(1):34–37

    Article  CAS  PubMed  Google Scholar 

  5. Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF (2008) Long distance running and knee osteoarthritis. A prospective study. Am J Prev Med 35(2):133–138

    Article  PubMed Central  PubMed  Google Scholar 

  6. Conaghan PG (2002) Update on osteoarthritis part 1: current concepts and the relation to exercise. Br J Sports Med 36(5):330–333

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Cymet TC, Sinkov V (2006) Does long-distance running cause osteoarthritis? J Am Osteopath Assoc 106(6):342–345

    PubMed  Google Scholar 

  8. Eckstein F, Heudorfer L, Faber SC, Burgkart R, Englmeier KH, Reiser M (2002) Long-term and resegmentation precision of quantitative cartilage MR imaging (qMRI). Osteoarthr Cartil 10(12):922–928

    Article  CAS  PubMed  Google Scholar 

  9. Eckstein F, Hudelmaier M, Putz R (2006) The effects of exercise on human articular cartilage. J Anat 208(4):491–512

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Eckstein F, Reiser M, Englmeier KH, Putz R (2001) In vivo morphometry and functional analysis of human articular cartilage with quantitative magnetic resonance imaging–from image to data, from data to theory. Anat Embryol (Berl) 203(3):147–173

    Article  CAS  Google Scholar 

  11. Eckstein F, Westhoff J, Sittek H, Maag KP, Haubner M, Faber S, Englmeier KH, Reiser M (1998) In vivo reproducibility of three-dimensional cartilage volume and thickness measurements with MR imaging. AJR Am J Roentgenol 170(3):593–597

    Article  CAS  PubMed  Google Scholar 

  12. Fredericson M, Misra AK (2007) Epidemiology and aetiology of marathon running injuries. Sports Med 37(4–5):437–439

    Article  PubMed  Google Scholar 

  13. Glaser C, Burgkart R, Kutschera A, Englmeier KH, Reiser M, Eckstein F (2003) Femoro-tibial cartilage metrics from coronal MR image data: technique, test-retest reproducibility, and findings in osteoarthritis. Magn Reson Med 50(6):1229–1236

    Article  PubMed  Google Scholar 

  14. Glaser C, Faber S, Eckstein F, Fischer H, Springer V, Heudorfer L, Stammberger T, Englmeier KH, Reiser M (2001) Optimization and validation of a rapid high-resolution T1-w 3D FLASH water excitation MRI sequence for the quantitative assessment of articular cartilage volume and thickness. Magn Reson Imaging 19(2):177–185

    Article  CAS  PubMed  Google Scholar 

  15. Graichen H, Jakob J, von Eisenhart-Rothe R, Englmeier KH, Reiser M, Eckstein F (2003) Validation of cartilage volume and thickness measurements in the human shoulder with quantitative magnetic resonance imaging. Osteoarthr Cartil 11(7):475–482

    Article  CAS  PubMed  Google Scholar 

  16. Graichen H, Springer V, Flaman T, Stammberger T, Glaser C, Englmeier KH, Reiser M, Eckstein F (2000) Validation of high-resolution water-excitation magnetic resonance imaging for quantitative assessment of thin cartilage layers. Osteoarthr Cartil 8(2):106–114

    Article  CAS  PubMed  Google Scholar 

  17. Graichen H, von Eisenhart-Rothe R, Vogl T, Englmeier KH, Eckstein F (2004) Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum 50(3):811–816

    Article  PubMed  Google Scholar 

  18. Hinterwimmer S, Krammer M, Krotz M, Glaser C, Baumgart R, Reiser M, Eckstein F (2004) Cartilage atrophy in the knees of patients after seven weeks of partial load bearing. Arthritis Rheum 50(8):2516–2520

    Article  CAS  PubMed  Google Scholar 

  19. Hohmann E, Wortler K, Imhoff AB (2004) MR imaging of the hip and knee before and after marathon running. Am J Sports Med 32(1):55–59

    Article  PubMed  Google Scholar 

  20. Hyhlik-Durr A, Faber S, Burgkart R, Stammberger T, Maag KP, Englmeier KH, Reiser M, Eckstein F (2000) Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence. Eur Radiol 10(2):297–303

    Article  CAS  PubMed  Google Scholar 

  21. Kavanagh T (1984) Distance running and cardiac rehabilitation: physiologic and psychosocial considerations. Clin Sports Med 3(2):513–526

    CAS  PubMed  Google Scholar 

  22. Kessler MA, Glaser C, Tittel S, Reiser M, Imhoff AB (2006) Volume changes in the menisci and articular cartilage of runners: an in vivo investigation based on 3-D magnetic resonance imaging. Am J Sports Med 34(5):832–836

    Article  PubMed  Google Scholar 

  23. Kessler MA, Glaser C, Tittel S, Reiser M, Imhoff AB (2008) Recovery of the menisci and articular cartilage of runners after cessation of exercise: additional aspects of in vivo investigation based on 3-dimensional magnetic resonance imaging. Am J Sports Med 36(5):966–970

    Article  PubMed  Google Scholar 

  24. Konradsen L, Hansen EM, Sondergaard L (1990) Long distance running and osteoarthrosis. Am J Sports Med 18(4):379–381

    Article  CAS  PubMed  Google Scholar 

  25. Krampla W, Mayrhofer R, Malcher J, Kristen KH, Urban M, Hruby W (2001) MR imaging of the knee in marathon runners before and after competition. Skelet Radiol 30(2):72–76

    Article  CAS  Google Scholar 

  26. Krampla WW, Newrkla SP, Kroener AH, Hruby WF (2008) Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10-year longitudinal study. Skeletal Radiol 37(7):619–626

    Article  PubMed  Google Scholar 

  27. Kretsch A, Grogan R, Duras P, Allen F, Sumner J, Gillam I (1984) 1980 Melbourne marathon study. Med J Aust 141(12–13):809–814

    CAS  PubMed  Google Scholar 

  28. Kunz M, Williams A, McKenzie C, Burstein D, Eckstein F (2005) No prolonged deformation of knee joint cartilage after the Boston marathon. Osteoarthr Cartil 13(Suppl 1):124

    Google Scholar 

  29. Kursunoglu-Brahme S, Schwaighofer B, Gundry C, Ho C, Resnick D (1990) Jogging causes acute changes in the knee joint: an MR study in normal volunteers. AJR Am J Roentgenol 154(6):1233–1235

    Article  CAS  PubMed  Google Scholar 

  30. Lane NE, Bloch DA, Wood PD, Fries JF (1987) Aging, long-distance running, and the development of musculoskeletal disability. A controlled study. Am J Med 82(4):772–780

    Article  CAS  PubMed  Google Scholar 

  31. Lane NE, Michel B, Bjorkengren A, Oehlert J, Shi H, Bloch DA, Fries JF (1993) The risk of osteoarthritis with running and aging: a 5 years longitudinal study. J Rheumatol 20(3):461–468

    CAS  PubMed  Google Scholar 

  32. Leiter JR, MacDonald L, McRae S, Davidson M, MacDonald PB (2012) Intrinsic stresses on bone and cartilage in the normal and anterior cruciate ligament-reconstructed knee before and after a half marathon: a magnetic resonance imaging analysis. Clin J Sport Med 22(5):439–442

    Article  PubMed  Google Scholar 

  33. Luke AC, Stehling C, Stahl R, Li X, Kay T, Takamoto S, Ma B, Majumdar S, Link T (2010) High-field magnetic resonance imaging assessment of articular cartilage before and after marathon running: does long-distance running lead to cartilage damage? Am J Sports Med 38(11):2273–2280

    Article  PubMed  Google Scholar 

  34. Mosher TJ, Liu Y, Torok CM (2010) Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running. Osteoarthr Cartil 18(3):358–364

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Mosher TJ, Smith HE, Collins C, Liu Y, Hancy J, Dardzinski BJ, Smith MB (2005) Change in knee cartilage T2 at MR imaging after running: a feasibility study. Radiology 234(1):245–249

    Article  PubMed  Google Scholar 

  36. Muhlbauer R, Lukasz TS, Faber TS, Stammberger T, Eckstein F (2000) Comparison of knee joint cartilage thickness in triathletes and physically inactive volunteers based on magnetic resonance imaging and three-dimensional analysis. Am J Sports Med 28(4):541–546

    CAS  PubMed  Google Scholar 

  37. Panush RS, Hanson CS, Caldwell JR, Longley S, Stork J, Thoburn R (1995) Is running associated with osteoarthritis? an 8 years follow-up study. J Clin Rheumatol 1(1):35–39

    Article  CAS  PubMed  Google Scholar 

  38. Panush RS, Schmidt C, Caldwell JR, Edwards NL, Longley S, Yonker R, Webster E, Nauman J, Stork J, Pettersson H (1986) Is running associated with degenerative joint disease? JAMA 255(9):1152–1154

    Article  CAS  PubMed  Google Scholar 

  39. Powell KE, Paffenbarger RS Jr (1985) Workshop on epidemiologic and public health aspects of physical activity and exercise: a summary. Public Health Rep 100(2):118–126

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Satterthwaite P, Larmer P, Gardiner J, Norton R (1996) Incidence of injuries and other health problems in the Auckland Citibank marathon, 1993. Br J Sports Med 30(4):324–326

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Satterthwaite P, Norton R, Larmer P, Robinson E (1999) Risk factors for injuries and other health problems sustained in a marathon. Br J Sports Med 33(1):22–26

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Schueller-Weidekamm C, Schueller G, Uffmann M, Bader TR (2006) Does marathon running cause acute lesions of the knee? evaluation with magnetic resonance imaging. Eur Radiol 16(10):2179–2185

    Article  CAS  PubMed  Google Scholar 

  43. Shellock FG, Deutsch AL, Mink JH, Kerr R (1991) Do asymptomatic marathon runners have an increased prevalence of meniscal abnormalities? an MR study of the knee in 23 volunteers. AJR Am J Roentgenol 157(6):1239–1241

    Article  CAS  PubMed  Google Scholar 

  44. Shellock FG, Mink JH (1991) Knees of trained long-distance runners: MR imaging before and after competition. Radiology 179(3):635–637

    CAS  PubMed  Google Scholar 

  45. Shellock FG, Morris E, Deutsch AL, Mink JH, Kerr R, Boden SD (1992) Hematopoietic bone marrow hyperplasia: high prevalence on MR images of the knee in asymptomatic marathon runners. AJR Am J Roentgenol 158(2):335–338

    Article  CAS  PubMed  Google Scholar 

  46. Smith TO, Drew BT, Toms AP, Donell ST, Hing CB (2012) Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 20(12):2367–2379

    Article  PubMed  Google Scholar 

  47. Sohn RS, Micheli LJ (1985) The effect of running on the pathogenesis of osteoarthritis of the hips and knees. Clin Orthop Relat Res 198:106–109

    PubMed  Google Scholar 

  48. Stahl R, Luke A, Ma CB, Krug R, Steinbach L, Majumdar S, Link TM (2008) Prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects—a 3.0 T magnetic resonance imaging study. Skelet Radiol 37(7):627–638

    Article  Google Scholar 

  49. Stammberger T, Eckstein F, Englmeier KH, Reiser M (1999) Determination of 3D cartilage thickness data from MR imaging: computational method and reproducibility in the living. Magn Reson Med 41(3):529–536

    Article  CAS  PubMed  Google Scholar 

  50. Stammberger T, Eckstein F, Michaelis M, Englmeier KH, Reiser M (1999) Interobserver reproducibility of quantitative cartilage measurements: comparison of B-spline snakes and manual segmentation. Magn Reson Imaging 17(7):1033–1042

    Article  CAS  PubMed  Google Scholar 

  51. Vanwanseele B, Eckstein F, Knecht H, Stussi E, Spaepen A (2002) Knee cartilage of spinal cord-injured patients displays progressive thinning in the absence of normal joint loading and movement. Arthritis Rheum 46(8):2073–2078

    Article  CAS  PubMed  Google Scholar 

  52. Williams PT (1997) Interactive effects of exercise, alcohol, and vegetarian diet on coronary artery disease risk factors in 9242 runners: the National Runners’ Health Study. Am J Clin Nutr 66(5):1197–1206

    CAS  PubMed  Google Scholar 

  53. Willick SE, Hansen PA Running and osteoarthritis. Clin Sports Med 29 (3):417–428

  54. Wong M, Carter DR (2003) Articular cartilage functional histomorphology and mechanobiology: a research perspective. Bone 33(1):1–13

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthias J. Feucht.

Additional information

Stefan Hinterwimmer and Matthias J. Feucht have contributed equally to this work and share first authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hinterwimmer, S., Feucht, M.J., Steinbrech, C. et al. The effect of a six-month training program followed by a marathon run on knee joint cartilage volume and thickness in marathon beginners. Knee Surg Sports Traumatol Arthrosc 22, 1353–1359 (2014). https://doi.org/10.1007/s00167-013-2686-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2686-6

Keywords

Navigation