In physically active females, there is a link between movement profile and lean mass. Specifically, individuals who possess excellent movement profiles have a greater amount of lean mass per unit of body weight as compared to those with poor movement profiles, thus decreasing their injury risk. However, movement profile does not appear to have an influence on cartilage thickness or quality and water content. Further, there seems to be an inverse relationship between lean muscle mass and cartilage thickness, as well as a positive relationship between movement profile and cartilage water content at rest as measured by musculoskeletal ultrasound.
Magnetic Resonance Imaging (MRI) allows for accurate and reproducible image analyses regarding all tissues of a joint, a quality that is extremely helpful when trying to determine if osteoarthritis is present in a joint. Of interest in this study, knee cartilage distribution is a tissue
type readily observed from MRI imaging of the knee, accessible across gender and lean body
mass make-ups.1, 2 While the use of MRI would be great for use in this study, it was not practical.
The most clinically accepted and feasible imaging tool for this study was ultrasound. Ultrasound as an imaging tool has been determined to be reliable, valid, accurate, and
effective to measure knee cartilage distribution and abnormalities.22, 40, 41 Data obtained from
ultrasound is both reproducible and has shown to have interobserver validity.40, 41 While this
imaging analysis cannot directly detect osteoarthritis as MRI can, this type of imaging can detect cartilage thickness, as well as cartilage damage and inflammation that may be linked to
osteoarthritis symptom flares.22
In this study, ultrasound imaging did not show any knee cartilage thickness differences between movement profile groups. However, ultrasound is still a sound method for measurement
Dual-energy x-ray absorptiometry (DXA) imaging proved to be a precise and accurate tool to
analyze lean body mass and bone mineral content, which coincides with previous literature
associated with the clinical implications of DXA scans.19 Using this imaging tool allows for
compartmentalized analyses of lean body mass, including lean mass, fat mass, and bone mineral
density.19 Because this study examined the lower extremity specifically, while also comparing
lean mass in the trunk, DXA provided the exact lean body mass data that was needed to
distinguish lean body mass between two groups: excellent movers and poor movers. The ability
to distinguish between different risk groups using DXA, where general lean body mass analyses
have only used this before, indicates that injury risk can potentially be observed by examining anatomical factors in the body without having to conduct movement analyses.
Differences were not found between groups, but in considering the physiological components of cartilage, this finding is not unexpected. Cartilage has protective properties that requires
chronic wear and tear to dissolve. This tissue is made up of a solid matrix and interstitial fluid
which is responsible for the initial load absorption.45 This fluid shifts as the load increases,
allowing for the solid matrix to absorb the load.45 This protective factor combined with the
understanding that there was no difference in cartilage thickness between movement profile groups allows for the assumption to be made that cartilage is equally protective regardless of injury risk.
Because there were not differences in cartilage between groups, these results suggest that movement alone does not explain knee cartilage thickness. In general, greater lean mass may lead to more dynamic loading of the muscle, rather than cartilage loading. When group was controlled for, a relationship between cartilage echo intensity and poor movers was observed, suggesting that the SAID (specific adaptation to imposed demands) principle, which explains
how tissue adapts to stresses placed upon it may contribute to knee cartilage and joint health.44 Work by Koo, Andriacchi, and Scanlan support that,in addition to the SAID principle, Wolff’s Law suggests that tissue changes as a result of the forces placed on it.46 Studies examining the influence of stress placement in the knee joint has shown that in healthy subjects, knee cartilage adapts based on the loading that it undergoes in order to maintain homeostasis.47 These studies have also shown that cartilage is thickest where this loading is most substantial.48 Further, these variations are individualized.49, 50 Both of these factors have the ability to be altered with training,
suggesting that if a person’s biomechanics are improved, their injury risk could be decreased. This can be seen in the between-group difference as excellent movers with lower injury risk had greater muscle mass quantities.
Current injury prevention practices for women include plyometric and proprioceptive
training which have “promising results” in altering neuromuscular control.43 Specifically, these
studies examine how to prevent knee ligament tears. Knee joint health, which can be affected by neuromuscular control, ligamentous tears and cartilage degradation, is crucial in the reducing the
risk of developing osteoarthritis.40, 43, 51 In terms of osteoarthritis progression and knee joint
health, these practices do contribute to overall health. However, an approach to protect knee cartilage is also necessary. Cartilage’s contribution to osteoarthritis symptom progression and
flare-ups prompts this need.22
This study showed that movement profile influences muscle mass and that a correlation exists between lean mass and cartilage thickness and quality. In fact, higher quantities of lean mass are correlated negatively with cartilage thickness and quality. There were no differences between groups in regards to knee thickness. However, the quality of cartilage between groups may be difference as a result of their biomechanics. Changes could potentially be made in the
knee joint by altering biomechanics and muscle mass to decrease injury risk and joint health
degradation. Observations have shown that lean mass has the potential to reduce injury risk as
seen in works by Singh and Singh, and promote healthy cartilage status per correlation analysis.19
These results have limitations. The sample size is an example of this, as data from only 40 subjects was measured. These results were also found based on physically active women pre- exercise, introducing an additional limit to it’s universality and ability to assume generalizations.
Regarding the measures used to collect data, ultrasound and DXA each have respective limitations. Ultrasound images and validity may be affected by the technician and potential technician error. Images obtained from ultrasound technology are also of poor resolution, making them difficult to analyze at times. DXA results are determined using the scan as well information on the subject’s demographics. Based on the technician, this information could be incorrect either by it’s input or when it was gathered.
Based on the significant values obtained from t-tests, a cause and effect may be
investigated between knee cartilage and lower extremity lean mass. From this, future studies involving movement profile and knee cartilage thickness should manipulate both muscle mass and movement profile to determine each variable’s specific influence on knee cartilage
thickness. These could be looked at individually as well as together, but a joint examination of both variables at once may prove to be more significant if their individual manipulation
influences are summed. There may be trouble in manipulating only the movement profile, as this can be altered in training which in itself can alter muscle mass.
Though the data analyzed based on ultrasound imaging did not prove to be significant,
the methods of cartilage thickness analysis, as well and lean body mass analysis, all proved to be
extremity lean mass, implications regarding movement profile and its influence on lower extremity lean mass can be created and further interventions put into place regarding injury
prevention, an important factor in preventing osteoarthritis.40, 51
References Sample (N=40)
SESSION I Jump-Landing Assessment (LESS Movement Screening) Classified as excellent, poor, or excluded
SESSION II
Poor (n=25) Low sagittal plane knee angles,
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Ultraasound - 120* and 145*
- 3 images recorded at each angle, Pre- and Post-testing
sessions
DXA
Analysis of body composition of the lower extremity
Excellent (n=25) High sagittal plane knee flexion angles with no presence of medial
knee collapse.
Ultrasound - 120* and 145*
- 3 images recorded at each angle, Pre- and Post-testing
sessions
DXA
Analysis of body composition of the lower extremity
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