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UDC 616.72-007.248-577.125 DOI: 10.14526/2070-4798-2022-17-2-191-197 Changes in biochemical status of athletes with Osgood-Schlatter disease
Nadezhda I. Manaeva13*, Renat Yu. Titukhov14, Natalya E. Gurova14, Dina B. Sumnaya24,
Anton A. Kinzerskxy13, Valentina A. Sadova13 4
'Ural State University of Physical Culture Russia, Chelyabinsk ORCID: 0000-0003-1120-2225, medcenteruzi@list.ru* ORCID: 0000-0001-6603-2185, renat99966'@yandex.ru ORCID: 0000-0001-5103-3249, natalyagur@mail.ru ORCID: 0000-0003-3'00-'''3 antkinz@list.ru ORCID: 0000-0001-7230-8002, val.l@mail.ru 2Scientific-research Institute of the Olympic Sport
Russia, Chelyabinsk ORCID:0000-000'-994'-8789, sumniyd@mail.ru 3Professor Kinzersky Clinic "Center of neuromuscular stabilization" Ltd.
Russia, Chelyabinsk
4"SONAR" Ltd. Russia, Chelyabinsk
Abstract: The most common complaint among children and teenagers is knee-joint pain. Among them, the most common reason for it is Osgood-Schlatter disease, which every fifth athlete has. Unfortunately, in many cases this happens without injuries or damage in anamnesis in case of normal, safe training. The aim of the research was to study the biochemical status of athletes with Osgood-Schlatter disease in order to determine the parameters for early diagnosis and rehabilitation planning of athletes with this pathology. Materials and Research methods. We examined 122 athletes on the basis of the training center of Professor Kinzersky Clinic and LLC Center of neuromuscular stabilization, Sports Medicine and Physical Rehabilitation Department, Biochemistry Department of the Ural State University of Physical Culture. 62 of them had Osgood-Schlatter disease (OSD).The athletes were examined by a rheumatologist and an orthopedist, and differential diagnosis of chondropathy with other autoimmune, autoinflammatory and infectious diseases of the musculoskeletal system was carried out. Laboratory study included the following: general clinical blood test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies (anti-CCP), modified citrullinated vimentin antibody (anti-MCV), creatinine, urea, aspartate amino transferase (AsAt), alanine aminotransferase (AlAt), total and ionized calcium, phosphorus, electrolytes, bilirubin and its fractions, total protein and its fractions, coagulogram, group B vitamins, vitamin D, magnesium. In the blood serum, the content of primary, secondary and final products of lipid peroxidation and the activity of the antioxidant systems of the organism were studied by the spectrophotometric method. In addition, we organized ultrasound investigation with elastometry, radiography and magnetic resonance imaging (MRI) of the knee joints. Results. Athletes with OSD have a deficiency of minerals, some essential amino acids and D hypovitaminosis together with a significant increase of alkaline phosphatase, which is the marker of bone resorption. Moreover, patients with chondropathy of the tibial tuberosity had a significant (p<0.05) increase in lipid peroxidation and a significant decrease in the antioxidant activity of blood serum. Conclusion. Measurement of lipid peroxidation products in blood serum can be used for early diagnosis of Osgood-Schlatter disease. Since these changes appear in the earliest (preclinical) stage of Osgood-Schlatter disease and they correlate with ultrasound and clinical data (r=-o.765--o.8oi). Key words: Osgood - Schlatter disease, tibial tuberosity chondropathy, blood serum biochemistry, lipid peroxidation, antioxidant system of organism.
For citation: Nadezhda I. Manaeva*, Renat Yu. Titukhov, Natalya E. Gurova, Dina B. Sumnaya, Anton A.
Kinzerskiy, Valentina A. Sadova. Changes in biochemical status of athletes with Osgood-Schlatter disease.
Russian Journal of Physical Education and Sport. 2022; 17(2): 151-155. DOI: 10.14526/2070-4798-202217-1-191-197.
Introduction
In case of tibial tuberosity chondropathy we deal with aseptic nonspecific inflammation [1]. In case of Osgood - Schlatter disease clinicians use ultrasound investigation data for the pathology monitoring [2]. The difficulty is in the fact that structural sonographic changes are delayed in time for several weeks and complete rehabilitation happens several months later [3]. During ultrasound investigation (USI) we can reveal anomalies, which surround kneecap tendons, such as reactive bursitis, kneecap tendon injuries, gristle edema and neovascularization in tibial tuberosity [4]. MRI in sagittal plane among the patients with OSD cam reveal distal aspects of kneecap tendon increase, sites of heterotopic ossification with low intensity of signal and uneven character or increase of tibial tuberosity. Stretching of deep infrapatellar bursa can be connected with liquid between deep surface of kneecap tendon and front cortex of tibia. In Т2-suspended pictures we can see the increased signal, which demonstrates tibial tuberosity edema and tibia epiphysis [5]. X-ray features appear later, when inconvertible changes of bone structure happen. Among them we see tuberosity fragmentation, bone tissue density increase or tibial colliculus increase [6]. The role of MRI and X-ray, in the opinion of the modern authors, in terms of OSD nowadays is restricted and has only differential- diagnostic character for different oncological masses and bone fracture elimination [7]. As etiology and pathogenesis are not studied enough, we use low informative ways of diagnostics [8]. Thus, it is urgent to search for such research method. It would be not only informative, but also available.
The aim of the research is to estimate biochemical status among the athletes with Osgood-Schlatter disease.
Materials and methods
We examined 122 athletes on the basis of the training center of Professor Kinzersky Clinic and LLC Center of neuromuscular stabilization, Sports Medicine and Physical Rehabilitation Department, Biochemistry Department of the Ural State University of Physical Culture. 62 of them had Osgood-Schlatter disease (OSD).
Criteria of inclusion into the research:
1. The age of athletes 11-19 years-old.
2. The absence of clinical-laboratory markers of acute infection, autoinflammatory state and chronic diseases recurrence
3. Confirmed diagnosis of tibial tuberosity chondropathy
4. Voluntary agreement of a patient (his representatives).
Criteria of elimination:
1. Athletes with the set diagnosis knee-joints osteoarthrosis.
2. Low compliance of a participant.
All athletes were divided into 2 groups: healthy, with Osgood-Schlatter disease.
The athletes were examined by a rheumatologist and an orthopedist, and differential diagnosis (clinical, laboratory [9,10], instrumental chondropathy with other autoimmune, autoinflammatory and infectious diseases of locomotor system) was carried out.
We carried out the following procedures among the patients:
1. Ultrasound investigation of knee joints with elastometry, using the apparatus of expert level Samsung Xario 2000.
2. Knee-joints X-ray.
3. If it was necessary joints MRI was fulfilled for differential diagnostics or in case of the supposition of joints structure and tissues around it damage after ultrasound investigation.
4. Laboratory study was realized in the set of clinics INVITRO, the clinic of South-Ural State Medical University and included the following: general clinical blood test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies (anti-CCP), modified citrullinated vimentin antibody (anti-MCV), creatinine, urea, aspartate amino transferase (AsAt), alanine aminotransferase (AlAt), total and ionized calcium, phosphorus, electrolytes, bilirubin and its fractions, total protein and its fractions, coagulogram, group B vitamins, vitamin D, magnesium. In the blood serum, the content of primary, secondary and final products of lipid peroxidation and the activity of the antioxidant systems of the organism were studied by the spectrophotometric method.
5. Goniometry.
6. Testing according to the scale of life quality estimation SF 36.
7. Visual estimation of pain according to Visual analogue scale (VAS).
Results and discussion
Biochemical research works showed (picture 1) that athletes with OSD have a deficiency of D vitamin, copper, ionized calcium (in terms of normal indices of general calcium), phosphorus, zinc, alkaline phosphatase level increase in terms of normal indices of AsAt and AlAt.
Fig. 1. The most important biochemical indices in blood serum in norm and among the examined patients
with OSD
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There was some amino acids dicrease in blood serum of athletes with OSD: lysine, proline, threonine, glycine, cysteine, arginine, glutamic acid, asparagine, leucine, glutamine, ornithine
The level of arginine was 1,91 ± 0,096 times (p< 0.05) lower than the norm. Arginine is irreplaceable (for children) amino acid. It is the key metabolite in nitrogen metabolism. It takes part in ammonia connection. Lack of arginine can lead to muscular tissue atrophy and vascular system disorder because of nitrogen monoxide syntheses decrease.
Lysine concentration among the patients with OSD was 1,77±0,089 times (p< 0.05) lower than normal indices. Lysine is an irreplaceable amino acid. It is necessary for albumins, hormones, enzimes, antisubstances creation; for tissues increase and rehabilitation (through taking part in collagen formation). The amino acid provides calcium assimilation and its delivery to bone tissue. Great amount of this amino acid can be found in collagen. It provides muscles, gristles, joints and tendons strength.
Athletes with OSD had a considerable ornithine level decrease in blood serum, 2,96±0,15 times lower than the norm. In spite of the fact, that ornithine can be replaced, it is arginine precursor. Great amount of ornithine is contained in connective tissue. Ornithine is the main assistant of connective tissue, as it strengthens tendons and joints, stimulates collagen production, accelerates reparation of connective tissue in case of injuries, hurts and distensions.
Athletes' proline was 2,65±0,13 times lower than the norm. Proline is a replaceable amino acid. It is important for collagen production (15% consists of proline), tissues renewal, energy synthesis in an organism, atherosclerosis prevention and
stable blood pressure preservation. It is the main component for connective tissue, gristles and joints support, friction decrease and fulfills the function of shock absorber.
Proline and lysine are the precursor of hydroxylysine and hydroxyproline, which take part in collagen synthesis, tendons and heart muscle formation. In sports nutrition they are used for muscle mass renewal and quick gathering.
The level of cysteine in blood serum was 2,26±0,11 times lower than the norm. Cysteine is an irreplaceable amino acid. It is used in an organism for taurine and glutathione synthesis. Taurine is necessary for visual organs, cardiovascular system functioning and it helps to increase muscle mass, decrease fat and control blood pressure. An active physical load, trainings, stress demand great amount of cysteine.
Glutamic acid among the athletes of the examined group was 1,64 ± 0,082 times lower than the norm. Glutamic acid is a natural neurotransmitter. It takes part in nitrogen metabolism, connects ammonia and other toxic substances. The need for glutamic acid appears in case of active physical loads, stress, depressions, nervous system diseases.
The level of aspartic acid was 2,21±0,12 times lower than the norm. Aspartic acid is a replaceable amino acid, central nervous system neurotransmitter, which provides somatotropin, testosterone and progesterone production. Moreover, it controls the work of thrombocytes, stimulates fibrinolysis. In case of OSD we should stimulate these processes for quick tuberosity and damaged joints reparation.
We also estimated the amount of lipid peroxidation products in blood serum (Fig. 2) and antioxidant activity of blood serum.
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Fig. 2. The ratio of lipid peroxidation products change among the athletes with Osgood - Schlatter
disease
Athletes with OSD had a valid (p<0,05) lipid peroxidation indices increase (picture 3) and considerable decrease of blood serum antioxidant activity.
With the help of spectrophotometric method we revealed the primary and secondary lipid peroxidation (LP) products increase (p<0,05) among the athletes with OSD, 1,22±0,061 and 1,15±0,058 times higher than in the control group.
Measuring the ratio of LP products in blood serum can be used for the effectiveness of rehabilitation estimation in case of Osgood - Schlatter disease. These changes correlate (r=-o,765--o,8oi) with ultrasonic and medical data.
Antioxidant activity of serum (Fig. 3) among the patients with OSD is validly lower than the norm (1,81±0,091 times (p<0,05)).
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Fig. 3. Antioxidant activity of blood serum among the athletes with Osgood - Schlatter disease
Conclusion
1. Athletes with OSD have vitamin D, copper, ionized calcium, phosphorus, zinc deficiency and the level of alkaline phosphatase increase.
2. We revealed some amino acids level decrease in blood serum of athletes with OSD: lysine, threonine, glycine, cysteine, arginine, glutamic acid, asparagine, leucine, glutamine, ornithine. This fact should be taken into consideration during nutrition support of athletes.
3. Measuring the ratio of LP products in blood serum can be used for the early diagnostics of Osgood - Schlatter disease, as these changes correlate with ultrasonic and medical data.
References
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Submitted: 10.03.2022 Author's information:
Nadezhda I. Manaeva - Post-graduate, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1, e-mail: medcenteruzi@list.ru
Dina B. Sumnaya - Doctor of Medical Sciences, Professor, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1, e-mail: sumniyd@mail.ru Anton A. Kinzerskiy - Candidate of Medical Sciences, Associate Professor, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1; e-mail: antkinz@list.ru Valentina A. Sadova - Candidate of Medical Sciences, Associate Professor, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1, e-mail: val.l@mail.ru Renat Yu. Titukhov - Post-graduate, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1, e-mail: renat999661@yandex.ru
Natalya E. Gurova - Post-graduate, Ural State University of Physical Culture, 454091, Russia, Chelyabinsk, Ordzhonikidze str., House 1, e-mail: natalyagur@mail.ru
