Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis

Koli, Jarmo; Multanen, Juhani; Häkkinen, Arja; Nieminen, Miika T.; Kautiainen, Hannu; Lammentausta, Eveliina; Jämsä, Timo; Ahola, Riikka; Selänne, Harri; Kiviranta, Ilkka; Heinonen, Ari

doi:10.1249/mss.0000000000000629

Cited by 34 publications

(35 citation statements)

References 37 publications

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“…This suggests that in the presence of higher compressive forces, upregulation of the proteoglycan and collagen synthesis in the extracellular matrix may occur as a chronic response to loading due to a higher mechanical stimulation of the chondrocytes[33,34]. This finding is comparable to the decreased T2 relaxation times found after a standardized training period, suggesting adaptations of the extracellular matrix due to the imposed mechanical loading[26,27]. Similarly higher shear forces are known to accelerate cartilage deterioration and can explain the lower proteoglycan concentration, reflected as higher T1ρ relaxation time[33,34].…”

Section: Discussionmentioning

confidence: 89%

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Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults

Rossom

Zevenbergen

et al. 2017

PLoS ONE

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Cartilage is responsive to the loading imposed during cyclic routine activities. However, the local relation between cartilage in terms of thickness distribution and biochemical composition and the local contact pressure during walking has not been established. The objective of this study was to evaluate the relation between cartilage thickness, proteoglycan and collagen concentration in the knee joint and knee loading in terms of contact forces and pressure during walking. 3D gait analysis and MRI (3D-FSE, T1ρ relaxation time and T2 relaxation time sequence) of fifteen healthy subjects were acquired. Experimental gait data was processed using musculoskeletal modeling to calculate the contact forces, impulses and pressure distribution in the tibiofemoral joint. Correlates to local cartilage thickness and mean T1ρ and T2 relaxation times of the weight-bearing area of the femoral condyles were examined. Local thickness was significantly correlated with local pressure: medial thickness was correlated with medial condyle contact pressure and contact force, and lateral condyle thickness was correlated with lateral condyle contact pressure and contact force during stance. Furthermore, average T1ρ and T2 relaxation time correlated significantly with the peak contact forces and impulses. Increased T1ρ relaxation time correlated with increased shear loading, decreased T1ρ and T2 relaxation time correlated with increased compressive forces and pressures. Thicker cartilage was correlated with higher condylar loading during walking, suggesting that cartilage thickness is increased in those areas experiencing higher loading during a cyclic activity such as gait. Furthermore, the proteoglycan and collagen concentration and orientation derived from T1ρ and T2 relaxation measures were related to loading.

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Section: Discussionmentioning

confidence: 89%

“…However T1ρ and T2 values were restored to baseline after 4 weeks of weight-bearing[25]. A decrease in T2 relaxation time was found after a standardized training period [26,27]. T1ρ relaxation times were increased after running a marathon[28].…”

Section: Introductionmentioning

confidence: 99%

Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults

Rossom

Zevenbergen

et al. 2017

PLoS ONE

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“…(34) Z is a measure of bone strength under bending and has increased after exercise interventions in older men, (10) premenopausal women, (35) and postmenopausal women. (41)(42)(43)(44) T2 relaxometry has been shown to be a reproducible method of assessing cartilage composition (25) and provides information on the free water content and collagen alignment within the articular cartilage. This change is similar to values reported in previous high-impact exercise studies.…”

Section: Discussionmentioning

confidence: 99%

“…There is little evidence of articular cartilage volume responding to increases in mechanical loading, (15,38) but the biochemical composition does respond to loading in both the short term (38)(39)(40) and following training interventions. (41)(42)(43)(44) T2 relaxometry has been shown to be a reproducible method of assessing cartilage composition (25) and provides information on the free water content and collagen alignment within the articular cartilage. (45) In the current study 12 regions of weight-bearing articular cartilage were analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…The strengths of this study are that it is a randomized trial with a duration that has been shown to be sufficient for both changes in bone (9) and cartilage. (41) This is the first study to investigate changes of knee OA imaging biomarkers in those without a diagnosis of OA (albeit with a substantial prevalence of pathology) and the first to use semiquantitative analysis to analyze any effects of high-impact exercise. To our knowledge there is only one previous study that has investigated both bone and cartilage outcomes following high-impact exercise in postmenopausal women (16) reporting similar findings to the current study.…”

Section: Discussionmentioning

confidence: 99%

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High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

Hartley

Folland

Kerslake

et al. 2019

Journal of Bone and Mineral Research

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High‐impact exercise can improve femoral neck bone mass but findings in postmenopausal women have been inconsistent and there may be concern at the effects of high‐impact exercise on joint health. We investigated the effects of a high‐impact exercise intervention on bone mineral density (BMD), bone mineral content (BMC), and section modulus (Z) as well as imaging biomarkers of osteoarthritis (OA) in healthy postmenopausal women. Forty‐two women aged 55 to 70 years who were at least 12 months postmenopausal were recruited. The 6‐month intervention consisted of progressive, unilateral, high‐impact exercise incorporating multidirectional hops on one randomly assigned exercise leg (EL) for comparison with the contralateral control leg (CL). Dual‐energy X‐ray absorptiometry (DXA) was used to measure BMD, BMC, and Z of the femoral neck. Magnetic resonance imaging (MRI) of the knee joint was used to analyze the biochemical composition of articular cartilage using T2 relaxometry and to analyze joint pathology associated with OA using semiquantitative analysis. Thirty‐five participants (61.7 ± 4.3 years) completed the intervention with a mean adherence of 76.8% ± 22.5%. Femoral neck BMD, BMC, and Z all increased in the EL (+0.81%, +0.69%, and +3.18%, respectively) compared to decreases in the CL (−0.57%, −0.71%, and −0.75%: all interaction effects p < 0.05). There was a significant increase in mean T2 relaxation times (main effect of time p = 0.011) but this did not differ between the EL and CL, indicating no global effect. Semiquantitative analysis showed high prevalence of bone marrow lesions (BML) and cartilage defects, especially in the patellofemoral joint (PFJ), with no indication that the intervention caused pathology progression. In conclusion, a high‐impact exercise intervention that requires little time, cost, or specialist equipment improved femoral neck BMD with no negative effects on knee OA imaging biomarkers. Unilateral high‐impact exercise is a feasible intervention to reduce hip fracture risk in healthy postmenopausal women. © 2019 American Society for Bone and Mineral Research.

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Sex‐Specific Influence of Quadriceps Weakness on Worsening Patellofemoral and Tibiofemoral Cartilage Damage: A Prospective Cohort Study

Culvenor

Segal

Guermazi

et al. 2019

Arthritis Care & Research

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Objective Reports on quadriceps weakness as a risk factor for incident and progressive knee osteoarthritis are conflicting, potentially due to differing effects of muscle strength on patellofemoral and tibiofemoral compartments. This study aimed to examine the sex‐specific relation of quadriceps strength to worsening patellofemoral and tibiofemoral cartilage damage over 84 months. Methods The Multicenter Osteoarthritis Study is a cohort study of individuals with or at risk for knee osteoarthritis. Maximal quadriceps strength was assessed at baseline. Cartilage damage was semiquantitatively assessed by magnetic resonance imaging at baseline and 84‐month follow‐up using the Whole‐Organ Magnetic Resonance Imaging Score (WORMS). Worsening patellofemoral and tibiofemoral cartilage damage was defined as any WORMS score increase in each subregion within medial and lateral compartments separately. Logistic regression with generalized estimating equations was used to assess the sex‐specific relation of quadriceps strength to worsening cartilage damage. Results A total of 1,018 participants (mean ± SD age 61 ± 8 years, and mean ± SD body mass index 29.3 ± 4.5 kg/m2; 64% female) were included. Quadriceps weakness increased the risk of worsening lateral patellofemoral cartilage damage in women (risk ratio for lowest versus highest quartile of strength 1.50 [95% confidence interval 1.03–2.20]; P = 0.007 for linear trend) but not in men. There was generally no association between quadriceps weakness and worsening cartilage damage in the medial or lateral tibiofemoral compartment for either women or men. Conclusion Low quadriceps strength increased the risk of worsening cartilage damage in the lateral patellofemoral joint of women, suggesting that optimizing quadriceps strength may help prevent worsening of structural damage in the patellofemoral joint in women.

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Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis

Abstract: Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.

Cited by 34 publications

References 37 publications

Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults

Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults

High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women

Sex‐Specific Influence of Quadriceps Weakness on Worsening Patellofemoral and Tibiofemoral Cartilage Damage: A Prospective Cohort Study

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