<![CDATA[Background: Acute running-related changes in cartilage oligomeric matrix protein (COMP) and the C-terminal cross-linked telopeptide of type II collagen (CTX-II) should not be interpreted automatically as structural cartilage injury. This review evaluated the magnitude and consistency of these biomarker responses after endurance running. Objective: To quantify the magnitude and consistency of the immediate post-run change in serum cartilage oligomeric matrix protein (COMP), and to summarize the corresponding CTX-II responses, in adults following endurance running. Methods: The protocol was registered in PROSPERO (CRD420261485170). PubMed/MEDLINE, CENTRAL, ClinicalTrials.gov, WHO ICTRP, OpenAlex, Crossref, and citation networks were searched for adult running studies reporting pre- and post-exercise COMP or CTX-II. The primary effect was the log ratio of immediate post-run to pre-run serum COMP. Random-effects models used restricted maximum likelihood with Hartung-Knapp inference. Results: The search identified 221 unique reports; seven reports met the criteria for qualitative synthesis, and four compatible healthy-adult COMP estimates involving 57 participants entered the meta-analysis. The pooled post/pre ratio was 1.132 (95% CI 0.794–1.613), with τ²=0.0365, I²=89.0%, and a 95% prediction interval of 0.560–2.286 at ρ=0.50. Three estimates increased and one decreased after running. CTX-II and recovery findings were too heterogeneous for pooling. Certainty was very low. Conclusion: Serum COMP may change acutely after endurance running, but the direction and magnitude are inconsistent. These short-term surrogate responses do not establish cartilage damage, protection, or long-term clinical harm.]]>
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