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Can marathon running improve knee damage of middle-aged adults? A prospective cohort study
  1. Laura Maria Horga1,
  2. Johann Henckel1,
  3. Anastasia Fotiadou1,
  4. Anna Hirschmann2,
  5. Camilla Torlasco3,
  6. Anna Di Laura1,
  7. Andrew D'Silva4,
  8. Sanjay Sharma4,
  9. James Moon3,
  10. Alister Hart1
  1. 1Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, London, UK
  2. 2Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
  3. 3Institute of Cardiovascular Science and Barts Heart Centre, University College London, London, UK
  4. 4Department of Cardiovascular Sciences, St. George's University of London, London, UK
  1. Correspondence to Dr Laura Maria Horga; laura.horga.17{at}


Objectives To evaluate the short-term impact of long-distance running on knee joints using MRI.

Methods 82 healthy adults participating in their first marathon underwent 3T (Tesla) MRI of both knees 6 months before and half a month after the marathon: 71 completed both the 4 month-long standardised training programme and the marathon; and 11 dropped-out during training and did not run the marathon. Two senior musculoskeletal radiologists graded the internal knee structures using validated scoring systems. Participants completed Knee Injury and Osteoarthritis Outcome Score questionnaires at each visit for self-reporting knee function.

Results Premarathon and pretraining MRI showed signs of damage, without symptoms, to several knee structures in the majority of the 82 middle-aged volunteers. However, after the marathon, MRI showed a reduction in the radiological score of damage in: subchondral bone marrow oedema in the condyles of the tibia (p=0.011) and femur (p=0.082). MRI did also show an increase in radiological scores to the following structures: cartilage of the lateral patella (p=0.0005); semimembranosus tendon (p=0.016); iliotibial band (p<0.0001) and the prepatellar bursa (p=0.016).

Conclusion Improvement to damaged subchondral bone of the tibial and femoral condyles was found following the marathon in novice runners, as well as worsening of the patella cartilage although asymptomatic. This is the most robust evidence to link marathon running with knee joint health and provides important information for those seeking to understand the link between long distance running and osteoarthritis of the main weight-bearing areas of the knee.

  • marathon
  • MRI
  • knee injuries
  • elderly people

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  • Contributors LMH, JH, AF, AHir, CT, ADS, SS, JM and AH developed the study concept and design. LMH, JH, AF, CT, ADL, ADS, SS, JM and AH contributed to the acquisition of data. LMH, AF, AHir contributed to the analysis of data. LMH, JH, AF, AHir, JM and AH contributed to the interpretation of data. LMH conducted the statistical analysis. All authors were involved in writing the manuscript. LMH, JH, JM and AH obtained the funding for the study data and analysis. LMH, CT, JM provided administrative, technical, material support for the study analysis. AH is the study supervisor. All authors had full access to the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. AH is the guarantor. The corresponding author LMH attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This research study was funded by patient donations and supported by researchers at the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The authors are also grateful to The Maurice Hatter Foundation, the RNOH Charity and the Rosetrees Trust for their support.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by NHS Research Ethics Committee (REC Reference Number 15/LO/0086).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.