Sports Medicine Research: In the Lab & In the Field: Patient-Reported Outcome Measures Are Associated to Biochemical Markers (Sports Med Res)
Monday, April 25, 2016

Patient-Reported Outcome Measures Are Associated to Biochemical Markers

Physical Activity Levels and Quality of Life Relate to Collagen Turnover and Inflammation Changes After Running

Cattano NM, Driban JB, Barbe MF, Tierney R, Amin M, Sitler MR.J Orthop Res. 2016: ahead of print

Take Home Message: Poor scores on the Knee Osteoarthritis Outcome Score and Tegner Activity Scale may be associated with elevated biomarker concentration levels that reflect collagen turnover.

Understanding the risk factors for early return to play following a musculoskeletal injury is important due to the increased chance for developing chronic injuries or never returning back to pre-injury activity levels. One potential solution to obtain a more definitive gauge on readiness to return is to measure biochemical markers (biomarkers). Therefore, the authors measured 22 athletes (11 with a history of ACL and/or meniscal surgery and 11 healthy matched controls) blood serum before and after a 30-minute set paced run on a treadmill to assess if pre-exercise patient-reported outcomes are related with biomarker changes of collagen turnover, inflammation, and bone/cartilage degeneration. Specifically, the authors measured 4 biomarkers important for collagen turnover: cartilage oligomeric matrix protein (COMP), c-terminal cross linking telopeptide of type II collagen (CTX-II), type II collagen fragments (CPII), CTX-II/CPII ratios. They also measured one inflammatory biomarker (interleukin-1β) and one biomarker of bone and cartilage degeneration (matrix metalloproteinase (MMP)-13). The patient-reported measures were Knee Osteoarthritis Outcomes Score (KOOS; 5 subscales for perceptions of pain, symptoms, knee health, and overall quality of life) and Tegner Activity Scale scores (to assess activity level). Athletes with a history of knee injury reported lower KOOS scores on all 5 subscales compared with healthy athletes. There were no differences in biomarker concentration levels between groups. However, ACL knee history patient’s pre-exercise quality of life score was negatively associated with post exercise interleukin-1β. Similarly, ACL knee history patient’s pre-exercise Tegner activity levels demonstrated a negative correlation to post exercise CTX-II/CPII ration. No other relationships were noted between pre and post exercise biomarkers and the patient-reported measures.

The authors found that measuring biomarker levels after an acute bout of running revealed relationships between pre exercise knee-related quality of life and activity levels. Each were negatively correlated; therefore, as quality of life and activity levels decline the amount of proteins reflective of collagen degradation and inflammation rose, which suggests that athletes with lower activity levels and lower quality of life experienced greater increases in collagen turnover and inflammation after only 30 minutes of running, respectively. It would be interesting to see how athlete’s biomarkers would respond after an intense game or a normal practice if 30 minutes of running could cause a measurable association between reported outcome and concentration level. It was also alarming to see that athletes with previous ACL or meniscal injury reported lower KOOS scores on all 5 subscales within previously injured group compared to controls; however, they were all cleared to return to play and there was also no difference in activity level reported between groups. Currently, medical professionals should be aware that pre-exercise self reported outcome may be able to identify athletes at risk for abnormal biomarker responses and lower quality of life that could lead to unhealthy changes in lifestyle behaviors.

Questions for Discussion: Do you use patient reported outcome measures to determine readiness to return to play? Would you use biomarker data to help aid in your return to play decision-making?

Written by: Jane McDevitt, PhD
Reviewed by: Stephen Thomas

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Cattano NM, Driban JB, Barbe MF, Tierney R, Amin M, & Sitler MR (2016). Physical activity levels and quality of life relate to collagen turnover and inflammation changes after running. Journal of Orthopaedic Research PMID: 27035929

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