Knees of ironman triathletes: Magnetic resonance imaging assessment of older (&gt;35 years old) competitors

Shellock, Frank G.; Hiller, W. D. B.; Ainge, George R.; Brown, David W.; Dierenfield, Laura

doi:10.1002/jmri.10234

Cited by 16 publications

(8 citation statements)

References 38 publications

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“…To that end, there is currently an ongoing randomized trial of 500 patients in Europe to determine whether general practitioners should refer patients with internal derangement of the knee for MRI or directly to a knee specialist. 16 Results from that and other studies may help determine the cost-effectiveness of knee MRI usage by primary care providers.…”

Section: Discussionmentioning

confidence: 95%

“…As described in several studies, knee MRI can find age-related degenerative changes that are not clinically significant. 2,6,16,19 These changes may include cartilage lesions, bone marrow edema patterns, and ligamentous and meniscal lesions. 11 A recent study by Englund et al 6 randomly evaluated 991 knee MRIs and 963 corresponding knee radiographs in symptomatic and asymptomatic ambulatory patients between the ages of 50 and 90 years.…”

Section: Discussionmentioning

confidence: 99%

“…4,7 However, in older patients, MRI can find age-related degenerative changes without clinical significance. 2,6,16,19 With the high prevalence of osteoarthritis (OA) in older patients (in an estimated 60% to 80% of people older than 55 years), 8 knee MRI findings may confound the diagnosis and treatment plans of primary care providers.…”

mentioning

confidence: 99%

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Use of Knee Magnetic Resonance Imaging by Primary Care Physicians in Patients Aged 40 Years and Older

Petron

Greis

Aoki

et al. 2010

Sports Health: A Multidisciplinary Approach

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Background:Criteria are needed for primary care providers such that they can evaluate age-related knee pain in a cost-effective manner. This study examined (1) in what percentage of patients are appropriate radiographic views of the knee ordered before magnetic resonance imaging (MRI) for knee pain, (2) specialists’ retrospective evaluation for appropriate utilization of MRI in knee pain, and (3) in what manner would the MRIs have altered diagnosis and management of knee disorders.Hypothesis:Primary care providers underuse appropriate radiographs—especially, flexion weightbearing posteroanterior films—and overuse MRIs when evaluating older patients with knee pain.Study Design:Case control.Methods:The authors performed a retrospective analysis of 100 patients older than 40 years with knee MRIs. Patient encounters with primary care physicians were reviewed. Given available information, specialists then formulated a pre- and post-MRI diagnosis and treatment plan and indicated whether the MRI would have altered their treatment.Results:Only 12 of 100 MRIs would have been ordered by an orthopaedist given the documented data. No MRIs would have been ordered in the 19 patients aged 60 years or older. Among 44 radiographs ordered, only 7 were flexion weightbearing. The most common pre-MRI diagnoses made by primary care providers were joint pain (22%) and meniscus injury (24%); the most common post-MRI diagnoses were osteoarthritis (40%) and degenerative meniscus injury (23%). In contrast, the 2 most common pre- and post-MRI diagnoses by specialists were osteoarthritis (28% and 37%, respectively) and degenerative meniscus injury (23% and 24%, respectively). Also, referrals to specialists increased from 9% pre-MRI to 76% post-MRI.Conclusion:Primary care providers may be overusing knee MRIs and underusing flexion weightbearing posteroanterior radiographs in patients older than 40 years with knee pain.Clinical relevance:Primary care providers should strongly consider not ordering knee MRI in patients with radiographic evidence of degenerative changes.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Use of Knee Magnetic Resonance Imaging by Primary Care Physicians in Patients Aged 40 Years and Older

Petron

Greis

Aoki

et al. 2010

Sports Health: A Multidisciplinary Approach

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“…Thinner anterior tibiae and the presence of oedema on magnetic resonance imaging (MRI) appears to be a precursor to stress fracture development, however [86]. In Ironman triathletes, the spectrum of abnormal MRI findings of the knee and shoulder was no greater than agerelated changes previously reported for other athletic populations and non-athletes [82,171]. Little else is known regarding the extent to which the susceptibility to skeletal problems of triathletes [81,83,170,172,173] is affected by training-induced modulation of circulating hormone levels [85,87] and/or relative energy deficiency in sport [174].…”

Section: Other Responses With Potential Health Consequencesmentioning

confidence: 92%

The Impact of Triathlon Training and Racing on Athletes’ General Health

2014

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Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries 'causing cessation or reduction of training or seeking of medical aid' are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9-2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.

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“…Puzzlingly, this severe injury does not always lead to symptoms (Shellock, 2003;Walczak, 2008). These asymptomatic lesions make diagnosis and management of cartilage injury a challenging task.…”

Section: Epidemiologymentioning

confidence: 99%

Chondrogenesis in a hyaluronic acid scaffold: comparison between chondrocytes and MSC from bone marrow and adipose tissue

Jakobsen

Shahdadfar

Reinholt

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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Treatment of focal lesions of the articular cartilage of the knee using chondrocytes in a hyaluronic acid (HA) scaffold is already being investigated in clinical trials. An alternative may be to use mesenchymal stem cells (MSC). We have compared articular chondrocytes with MSC from human bone marrow (BM) and adipose tissue (AT), all cultured in HA scaffolds, for their ability to express genes and synthesize proteins associated with chondrogenesis. The cells were expanded in monolayer cultures. After seeding into the scaffold, the chondrocytes were maintained in medium, while the two MSC populations were given a chondrogenic differentiation medium. Chondrogenesis was assessed by real-time RT-PCR for chondrocyte-associated genes, by immunohistochemistry and by ELISA for collagens in the supernatant. Redifferentiation of the dedifferentiated chondrocytes in the HA scaffold was shown by a modest increase in type II collagen mRNA (COL2A1) and reduction in COL1A1. BM-MSC expressed 600-fold higher levels of COL2A1 than chondrocytes after 3 weeks in the scaffold. The levels of aggrecan (AGC1) and COL1A1 were similar for chondrocyte and BM-MSC scaffold cultures, while COL10A1 was higher in the BM-MSC. AT-MSC expressed levels of COL2A1 and COL1A1 similar to chondrocytes, but less AGC1 and COL10A1. Surprisingly, little collagen II protein was observed in the scaffold. Instead, collagen II was found in the culture medium. Chondrogenesis in HA scaffolds was more efficient using BM-MSC than AT-MSC or chondrocytes. Some of the secreted collagen II escaped entrapment in the extracellular space and was detected in the culture medium.

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Knees of ironman triathletes: Magnetic resonance imaging assessment of older (>35 years old) competitors

Cited by 16 publications

References 38 publications

Use of Knee Magnetic Resonance Imaging by Primary Care Physicians in Patients Aged 40 Years and Older

Use of Knee Magnetic Resonance Imaging by Primary Care Physicians in Patients Aged 40 Years and Older

The Impact of Triathlon Training and Racing on Athletes’ General Health

Chondrogenesis in a hyaluronic acid scaffold: comparison between chondrocytes and MSC from bone marrow and adipose tissue

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