Skip to main content
SpringerLink
Log in

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

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects. To compare the diagnostic performance of cartilage-dedicated magnetic resonance imaging (MRI) sequences at 3.0 T.

Materials and methods

Ten marathon runners underwent 3.0 T MRI 2–3 days before and after competition. Twelve physically active asymptomatic subjects not performing long-distance running were examined as controls. Pathologic condition was assessed with the whole-organ magnetic resonance imaging score (WORMS). Cartilage abnormalities and bone marrow edema pattern (BMEP) were quantified. Visualization of cartilage pathology was assessed with intermediate-weighted fast spin-echo (IM-w FSE), fast imaging employing steady-state acquisition (FIESTA) and T1-weighted three-dimensional (3D) high-spatial-resolution volumetric fat-suppressed spoiled gradient-echo (SPGR) MRI sequences.

Results

Eight of ten marathon runners and 7/12 controls showed knee abnormality. Slightly more and larger cartilage abnormalities, and BMEP, in marathon runners yielded higher but not significantly different WORMS (P > 0.05) than in controls. Running a single marathon did not alter MR findings substantially. Cartilage abnormalities were best visualized with IM-w FSE images (P < 0.05).

Conclusion

A high prevalence of knee abnormalities was found in marathon runners and also in active subjects participating in other recreational sports. IM-w FSE sequences delineated more cartilage MR imaging abnormalities than did FIESTA and SPGR sequences.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hunt A. Musculoskeletal fitness: the keystone in overall well-being and injury prevention. Clin Orthop Relat Res 2003; (409): 96–105.

    Article  Google Scholar 

  2. Colbert LH, Hootman JM, Macera CA. Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study. Clin J Sport Med 2000; 10: 259–263.

    Article  CAS  Google Scholar 

  3. Bachmann GF, Basad E, Rauber K, Damian MS, Rau WS. Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients. Eur Radiol 1999; 9: 145–152.

    Article  CAS  Google Scholar 

  4. Buckwalter JA, Martin JA. Sports and osteoarthritis. Curr Opin Rheumatol 2004; 16: 634–639.

    Article  Google Scholar 

  5. Derrick TR. The effects of knee contact angle on impact forces and accelerations. Med Sci Sports Exerc 2004; 36: 832–837.

    Article  Google Scholar 

  6. Lazzarini KM, Troiano RN, Smith RC. Can running cause the appearance of marrow edema on MR images of the foot and ankle? Radiology 1997; 202: 540–542.

    Article  CAS  Google Scholar 

  7. Lohman M, Kivisaari A, Vehmas T, Kallio P, Malmivaara A, Kivisaari L. MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal Radiol 2001; 30: 61–66.

    Article  CAS  Google Scholar 

  8. Schueller-Weidekamm C, Schueller G, Uffmann M, Bader T. Incidence of chronic knee lesions in long-distance runners based on training level: findings at MRI. Eur J Radiol 2006; 58: 286–293.

    Article  Google Scholar 

  9. Lane NE, Michel B, Bjorkengren A, Oehlert J, Shi H, Bloch DA, et al. The risk of osteoarthritis with running and aging: a 5-year longitudinal study. J Rheumatol 1993; 20: 461–468.

    CAS  PubMed  Google Scholar 

  10. Panush RS, Schmidt C, Caldwell JR, Edwards NL, Longley S, Yonker R, et al. Is running associated with degenerative joint disease? JAMA 1986; 255: 1152–1154.

    Article  CAS  Google Scholar 

  11. Spector TD, Harris PA, Hart DJ, Cicuttini FM, Nandra D, Etherington J, et al. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum 1996; 39: 988–995.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  14. Barr C, Bauer JS, Malfair D, Ma B, Henning TD, Steinbach L, et al. MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. Eur Radiol 2007; 17: 1518–1528.

    Article  Google Scholar 

  15. Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5 T and 3.0 T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005; 46: 67–73.

    Article  CAS  Google Scholar 

  16. Kijowski R, Blankenbaker D, Davis K, Shinki K, Kaplan L, De Smet A. Comparison of 1.5 T and 3 T magnetic resonance imaging systems for evaluating the articular cartilage of the knee joint (abstract). Radiological Society of North America Scientific Assembly and Annual Meeting Program, Oak Brook, Ill: Radiological Society of North America, 2007; 125.

  17. Masi JN, Sell CA, Phan C, Han E, Newitt D, Steinbach L, et al. Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model. Radiology 2005; 236: 140–150.

    Article  Google Scholar 

  18. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198): 43–49.

  19. Haacke EM, Wielopolski PA, Tkach JA, Modic MT. Steady-state free precession imaging in the presence of motion: application for improved visualization of the cerebrospinal fluid. Radiology 1990; 175: 545–552.

    Article  CAS  Google Scholar 

  20. Banerjee S, Han ET, Krug R, Newitt DC, Majumdar S. Application of refocused steady-state free-precession methods at 1.5 and 3 T to in vivo high-resolution MRI of trabecular bone: simulations and experiments. J Magn Reson Imaging 2005; 21: 818–825.

    Article  Google Scholar 

  21. Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D, et al. Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12: 177–190.

    Article  CAS  Google Scholar 

  22. Gluer CC, Blake G, Lu Y, Blunt BA, Jergas M, Genant HK. Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int 1995; 5: 262–270.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  24. Kuo R, Panchal M, Tanenbaum L, Crues JV 3rd. 3.0 Tesla imaging of the musculoskeletal system. J Magn Reson Imaging 2007; 25: 245–261.

    Article  Google Scholar 

  25. Beattie KA, Boulos P, Pui M, O’Neill J, Inglis D, Webber CE, et al. Abnormalities identified in the knees of asymptomatic volunteers using peripheral magnetic resonance imaging. Osteoarthritis Cartilage 2005; 13: 181–186.

    Article  CAS  Google Scholar 

  26. Boks SS, Vroegindeweij D, Koes BW, Hunink MM, Bierma-Zeinstra SM. Magnetic resonance imaging abnormalities in symptomatic and contralateral knees: prevalence and associations with traumatic history in general practice. Am J Sports Med 2006; 34: 1984–1991.

    Article  Google Scholar 

  27. Hill CL, Gale DR, Chaisson CE, Skinner K, Kazis L, Gale ME, et al. Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without symptoms. Arthritis Rheum 2003; 48: 2836–2844.

    Article  Google Scholar 

  28. Tschirch FT, Schmid MR, Pfirrmann CW, Romero J, Hodler J, Zanetti M. Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol 2003; 180: 1431–1436.

    Article  Google Scholar 

  29. Ludman CN, Hough DO, Cooper TG, Gottschalk A. Silent meniscal abnormalities in athletes: magnetic resonance imaging of asymptomatic competitive gymnasts. Br J Sports Med 1999; 33: 414–416.

    Article  CAS  Google Scholar 

  30. Major NM, Helms CA. MR imaging of the knee: findings in asymptomatic collegiate basketball players. AJR Am J Roentgenol 2002; 179: 641–644.

    Article  Google Scholar 

  31. Kaplan LD, Schurhoff MR, Selesnick H, Thorpe M, Uribe JW. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy 2005; 21: 557–561.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  33. Kessler MA, Glaser C, Tittel S, Reiser M, Imhoff AB. 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 2006; 34: 832–836.

    Article  Google Scholar 

  34. Mosher TJ, Smith HE, Collins C, Liu Y, Hancy J, Dardzinski BJ, et al. Change in knee cartilage T2 at MR imaging after running: a feasibility study. Radiology 2005; 234: 245–249.

    Article  Google Scholar 

  35. Kim HJ, Lee YH, Kim CK. Biomarkers of muscle and cartilage damage and inflammation during a 200 km run. Eur J Appl Physiol 2007; 99: 443–447.

    Article  CAS  Google Scholar 

  36. Link TM, Stahl R, Woertler K. Cartilage imaging: motivation, techniques, current and future significance. Eur Radiol 2007; 17: 1135–1146.

    Article  Google Scholar 

  37. Kornaat PR, Reeder SB, Koo S, Brittain JH, Yu H, Andriacchi TP, et al. MR imaging of articular cartilage at 1.5T and 3.0T: comparison of SPGR and SSFP sequences. Osteoarthritis Cartilage 2005; 13: 338–344.

    Article  CAS  Google Scholar 

  38. Potter HG, Foo LF. Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med 2006; 34: 661–677.

    Article  Google Scholar 

  39. Bredella MA, Tirman PF, Peterfy CG, Zarlingo M, Feller JF, Bost FW, et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol 1999; 172: 1073–1080.

    Article  CAS  Google Scholar 

  40. Figueroa D, Calvo R, Vaisman A, Carrasco MA, Moraga C, Delgado I. Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings. Arthroscopy 2007; 23: 312–315.

    Article  Google Scholar 

  41. Friemert B, Oberlander Y, Schwarz W, Haberle HJ, Bahren W, Gerngross H, et al. Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study. Knee Surg Sports Traumatol Arthrosc 2004; 12: 58–64.

    Article  CAS  Google Scholar 

  42. Saadat E, Jobke B, Cheng J, Li X, Bolbos R, Ries MD, et al. Diagnostic performance of in vivo MRI for articular cartilage abnormalities in human osteoarthritic knees using histology with safranin-O staining as a standard of reference (abstract 310). OARSI 2007 World Congress on Osteoarthritis, 6–9 December 2007; Fort Lauderdale, Fla.

Download references

Author information

Authors and Affiliations

  1. Musculoskeletal and Quantitative Imaging Group, Department of Radiology, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107-0946, USA

    Robert Stahl, Roland Krug, Lynne Steinbach, Sharmila Majumdar & Thomas M. Link

  2. Department of Clinical Radiology, University Hospitals-Campus Grosshadern, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Robert Stahl

  3. Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA

    Anthony Luke & C. Benjamin Ma

  4. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

    Anthony Luke

Authors
  1. Robert Stahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony Luke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Benjamin Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roland Krug
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lynne Steinbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sharmila Majumdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas M. Link
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Stahl.

Additional information

This work was supported by the Research Evaluation and Allocation Committee (REAC) of the University of California, San Francisco, CA, USA, through the Clough G Memorial Endowment Fund, and by GlaxoSmithKline (GSK) plc, Research and Development, London, UK.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stahl, R., Luke, A., Ma, C.B. et al. 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. Skeletal Radiol 37, 627–638 (2008). https://doi.org/10.1007/s00256-008-0491-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-008-0491-y

Keywords

Search

Navigation