Objectives:
Extreme Triathlon (ET) races have been increasing around the world over the last decade. That refers to a long-distance triathlon where competitors are submitted to more extreme courses and conditions due to the remote locations and large elevation changes. The impact of an ET can lead to excessive stress on the body, resulting in musculoskeletal injuries. Since the knee is the joint that holds most of the injuries among triathlon athletes, the present study aimed to evaluate the influence of an ET participation on the competitor's knee.
Methods
Experienced athletes of the 2019 FODAXMAN® Extreme Triathlon (4km swim, 173km bike with 3650m accumulated altimetry and 42km run with 1250m accumulated altimetry) with asymptomatic knee and no history of surgeries were included. All athletes underwent standard knee examination and answered the International Knee Documentation Committee (IKDC) Subjective Knee Score and the Short Form-12 Item Health Survey (SF-12) questionaries as a measure of knee function. Additionally, an MRI of the dominant limb knee was performed using conventional pulse sequences and a clinical 1.5 T MRI system, and the Whole-Organ Magnetic Resonance Imaging Score (WORMS) applied. All the evaluations, questionnaires and MRI scans were done 48 hours before and after the race.
Results
Nine athletes (mean age 41.6 ± 3.8 years, 1 female, 8 males) were included in the study. All of them have finished the competition. There was no IKDC (pre 83,4±12,9; pos 85,4±10,8; p=0,661) or SF-12 (pre 52,6±4,7; pos 52,8±7,7; p=0,968) statistically difference before and after the race.The MRI scans showed that only one knee presented synovitis as structural abnormality after the race. No other previous injuries were aggravated. This way, there was no WORMS score statistically difference (p=0,317). Only one competitor had no structural abnormalities and among the others cartilage loss was the most prevalent feature (100%).
Conclusion
The study is probably underpowered due to the limited number of only 9 subjects and the absence of statistically significant differences can be an error type II. Nevertheless, despite having been exposed to one of the most intense physical demanding races known, we could not find any new acute relevant findings related to knee function or physical structure among the competitors. Although there is a need for further studies on the subject, we suppose that being an experienced and very well-trained athlete was essential to avoid injuries despite the challenge imposed.