Preclinical Cartilage Changes of the Knee Joint in Adolescent Competitive Volleyball Players: A Prospective T2 Mapping Study

Abstract

Purpose To investigate the potential effects of volleyball as a competitive sport in adolescence on the cartilage of knee joints using T2 mapping in MRI and identification of preclinical cartilage changes. Volleyball as an impact sport often leads to damage of the knee joint cartilage in adulthood. As T2 mapping is widely available and highly capable of detecting cartilage changes prior to conventional MRI sequences, such a detection may allow adolescent volleyball players to change their training regime before structural damage can occur to the cartilage and pose the risk of osteoarthritis.

Materials and Methods Comparative study of the patellar, femoral, and tibial cartilage of 60 knee joints using T2 mapping on 3 T MRI. In each case, both knees of 15 adolescent competitive volleyball athletes were compared with 15 controls.

Results In the group of competitive athletes, more focal cartilage changes were detected in the medial facet of the patellofemoral cartilage and in the medial femoral condyle of the knee joint cartilage (p = .01 and p <.05, respectively). Furthermore, the latter showed a diffused increase in maximal T2 mapping values (p <.04 right and p = .05 left). The distribution of changes seems to further depend on the player’s position.

Conclusion In adolescent volleyball players in competitive sports, T2 mapping demonstrates early cartilage changes in both the patellofemoral and medial femoral cartilages. The distribution of lesions depends on the player’s position. Since the cascade from T2 relaxation time increase to conspicuous cartilage damage is well established, early counter-regulation (e. g., adapted training profile, targeted physiotherapy, and appropriate muscle building training) has the potential to prevent later damage.

Key Points: 

1. Volleyball as a competitive sport in adolescence leads to preclinical knee cartilage changes.

2. Cartilage changes are both focal and diffuse.

3. Jumping-intensive player positions seem to show more patellofemoral and running-intensive more condylar cartilage changes.

4. Early detection of these changes could prevent progression to cartilage damage through adapted training.

Citation Format

• Roth C, Hirsch F, Sorge I et al. Preclinical Cartilage Changes of the Knee Joint in Adolescent Competitive Volleyball Players: A Prospective T2 Mapping Study. Fortschr Röntgenstr 2023; 195: 913 – 923

Zusammenfassung

Ziel Es sollen die Auswirkungen von Volleyball als Leistungssport im Jugendalter auf den Knorpel der Kniegelenke mittels T2-Mapping in der MRT untersucht werden und nach präklinischen Knorpelveränderungen gefahndet werden. Volleyball auf Hochleistungsniveau führt als Impact-Sportart im Erwachsenenalter häufig zu Schäden am Kniegelenksknorpel. Das T2-Mapping des Kniegelenksknorpels in der MRT ist ein exzellentes und breitflächig verfügbares Verfahren zur Detektion von diffusen und regionalen Knorpelveränderungen, noch bevor diese in den gängigen MR-Sequenzen wie PD-FS, T1 und T2 sichtbar werden. Dies kann den Betroffenen eine Verhaltensänderung ermöglichen, noch bevor sich strukturelle Knorpelschäden mit der Gefahr einer Arthrose etablieren können.

Material und Methoden Vergleichende MR-Untersuchung jeweils beider Kniegelenke von 15 jugendlichen Leistungssportlern im Volleyball mit 15 Kontrollen mittels T2-Mapping des retropatellaren Knorpels und des Kniegelenksknorpels.

Ergebnisse Bei den Leistungssportlern lassen sich sowohl am retropatellaren Knorpel im Bereich der medialen Facette als auch im Bereich des Deckknorpels der medialen Femurkondyle signifikant mehr fokale Knorpelveränderungen (p = .01 respektive p <.05) nachweisen als bei den Kontrollen. Der Knorpel der medialen Femurkondyle zeigt darüber hinaus diffus im gesamten Knorpel eine signifikante Steigerung der maximalen T2-Relaxationszeiten bei den Leistungssportlern (p <.04 rechts und p = .05 links). Die Verteilung der Veränderungen scheint zusätzlich von der Spielerposition abhängig zu sein.

Schlussfolgerung Bei adoleszenten Volleyballern im Leistungssport sind mittels T2-Mapping frühe Knorpelveränderungen sowohl am retropatellaren als auch am medialen femoralen Knorpel nachweisbar, wobei die Verteilung der Läsionen von der Spielerposition abhängt. Da die Abfolge aus T2-Relaxationszeiterhöhung zu offensichtlichen Knorpelschäden gut belegt ist, könnte eine frühe Gegenregulation (z. B. durch ein angepasstes Trainingsprofil, gezielte Physiotherapie und entsprechendes Muskelaufbautraining) spätere Schäden verhindern.

Kernaussagen: 

1. Volleyball als Leistungssport im Jugendalter führt zu präklinischen Knieknorpelveränderungen.

2. Die Knorpelveränderungen zeigen sich sowohl fokal als auch diffus.

3. Sprungintensive Spielerpositionen scheinen eher retropatellare und laufintensive mehr kondyläre Knorpelveränderungen aufzuweisen.

4. Die Früherkennung dieser Veränderungen könnte durch adaptiertes Training das Fortschreiten hin zu manifesten Knorpelschäden verhindern.

Key words

cartilage - T2 mapping - pediatric - volleyball - knee

Publication History

Received: 29 January 2023

Accepted: 16 April 2023

Article published online:
24 May 2023

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