MR-tomografische Veränderungen an Achillessehne und Rückfuß von Laufanfängern und Lauferfahrenen im Trainingsverlauf und nach einem (Halb-)Marathon

Zusammenfassung

Hintergrund: Der Marathonlauf wird immer populärer und bei dem verbreiteten sitzenden Lebenswandel sind die positiven Auswirkungen auf Stoffwechsel und Herz-Kreislauf-system unbestritten. Unklar ist jedoch die Frage nach vorzeitigem Gelenk- und Sehnenverschleiß. Es wurden geübte und ungeübte Läufer in der Vorbereitungszeit und direkt nach einem Marathonlauf MR-tomografisch und klinisch untersucht, um eventuelle Schäden an Achillessehne (AS) und Rückfuß zu beurteilen. Material und Methode: Prospektive Beobachtungsstudie einer Kohorte von 73 Läufern aus den Anmeldungen zu einem Stadtlauf. Die Teilnehmer wurden vor Beginn des Trainings, gegen Ende des Trainings und direkt (maximal 72 Stunden) nach einem Marathonlauf klinisch-orthopädisch und kernspintomografisch mit 2 geblindeten Beurteilern auf Veränderungen an AS und Rückfuß untersucht. Die Zielgrößen waren Läsionen mit Signalsteigerung in der STIR-Wichtung. Die Ergebnisse wurden zwischen den Subgruppen der Läufer verglichen, außerdem wurde eine Faktorenanalyse durchgeführt. Jeweils wurde bei p ≤ 0,05 von Signifikanz ausgegangen. Ergebnisse: Es wurden 32 Frauen und 41 Männer eingeschlossen, von denen 53 die geplante Distanz liefen (Finisher), während 20 als Nonfinisher vorzeitig abbrachen. Es gab 28 erfahrene und 25 unerfahrene Läufer, 14 Läufer hatten Fußbeschwerden während des Trainings und 13 während des Marathons. Es war eine signifikante positive Korrelation zwischen AS-Durchmesser und Gewicht (r = 0,37) bzw. Körpergröße (r = 0,34), aber eine negative Korrelation zwischen Körpergröße und Signalintensität des Kalkaneus (r = −0,50) festzustellen. Der Mittelwert der Signalintensität der asymptomatischen AS nahm im Training ab. Es kam nach dem Lauf zu einer Zunahme des mittleren Volumens der Bursa retrocalcanea sowie des mittleren Läsionsvolumens in der AS, das mittlere MR-Signal im Kalkaneus nahm ab. Die Interraterreliabilität der Messungen war mittelgradig bis exzellent. Schlussfolgerung: Ein planmäßiges Training auf einen Marathonlauf erlaubt eine Adaptation der muskuloskeletalen Strukturen an die zunehmende Belastung. Es wurden weder in der Vorbereitung noch direkt nach dem Marathon regelhafte neue Schäden festgestellt.

Abstract

Background: Marathon running is gaining in popularity. Its benefits regarding the cardiovascular system as well as the metabolism are beyond doubt. However, whether or not there are detrimental side effects to the musculoskeletal system such as wear and tear is an unsolved question. We therefore prospectively looked at beginners and experienced runners at a city marathon during training and after the competition for lesions to the Achilles tendon (AT) or hindfoot. Material and Method: 73 healthy subjects were prospectively included in our study. They were recruited from the applicants of the city marathon or half-marathon. They underwent an initial clinical orthopaedic as well as three magnetic resonance (MRI) examinations. The MRI were conducted at the time point of study enrolment, near the end of training and directly (up to 72 hours) after the run. MRI evaluation (fat saturated T₂-weighted sagittal STIR sequence) was performed by two independent experienced radiologists blinded to the clinical context. The results were compared for subgroups of runners, also a factorial analysis was performed. Statistical results were deemed significant for p ≤ 0.05. Results: 32 women and 41 men were included. In the end there were 53 finishers and 20 non-finishers; 28 seasoned runners and 25 novices. 57 runners had no foot complaints, while 14 had foot pain during training and 13 during the marathon. Mean body weight was 71.6 kg, height was 173 cm, age was 40.2 years. Mean AT diameter was 7.0 mm and showed no change during training or after the marathon. There was no significant influence of gender on other variables investigated. There was a significant and positive correlation between AT diameter and weight (r = 0.37), also AT and height (r = 0.34), while there was negative correlation between height and signal intensity of calcaneus (r = −0.50). The signal intensity of the AT decreased during training. The signal intensity of the calcaneus decreased from inclusion until after the marathon, while the mean retrocalcanear bursa volume and AT lesion volume increased. Some of the non-finishers stopped the training because of orthopaedic symptoms. These runners generally had an apparent lesion visible in their initial MRI examination. Regarding the factorial analysis of the data, there were no risk factors predicting non-finishing or development of new lesions to be detected. Interrater reliability was moderate for retrocalcanear bursa, while it was good to excellent for AT diameter and calcaneus MR signal intensity. Conclusion: In our sample of primarily asymptomatic German runners, the AT diameter was higher than in symptomatic American patients. The diameter did not change during training or after the marathon. Non-finishers with orthopaedic reasons generally had a lesion on MRI in the initial examination. Apart from this, no new lesions to the AT or hindfoot are to be expected during normal training. Adaptive processes seem to be the main effect of this training.

Schlüsselwörter

Achillessehne - Marathon - degeneration - MRT - Bursitis

Key words

Achilles tendon - marathon - degeneration - MRI - bursitis

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