The Natural History of the Development and Resolution of Achilles and Patellar Tendon Sonographic Abnormalities in a Collegiate Cohort

Abstract

Purpose: To prospectively identify the development and regression of Achilles and patellar sonographic abnormalities in collegiate athletes. Methods: Prior to the beginning of their seasons, the Achilles and patellar tendons of collegiate athletes were sonographically videoed by an experienced sonographer. Subjects were then re-recorded at the end of 1 year of competition in an identical manner. Measurements were obtained using consistent predetermined protocols for each participant. Videos of the results were assessed in a blinded manner for echogenicity, tendon thickening, and neovascularization. Results: A total of 147 patellar and 148 Achilles tendons were recorded, with 40.1% of patellar and 16.2% of Achilles tendons identified to have abnormalities at baseline. Of all tendons analyzed, zero patellar and one Achilles tendon were transformed from “abnormal” to “normal”—this single tendon showed only a single neovessel without hypoechogenicity or thickening. Of all tendons initially categorized as “normal,” only 4 patellar tendons switched categories to “abnormal” by the second scan, all with new hypoechogenic foci. Amongst these, all participants were asymptomatic. Conclusions: This prospective study demonstrated that all Achilles and patellar tendons with sonographic abnormalities remain abnormal after 1 year of training and competition, with the exception of a single neovessel on one Achilles tendon that disappeared. A small percentage of collegiate student-athletes developed new abnormalities over a year of practice and competition. This may refute the idea that tendinosis comes and goes in this athletic population, given the minimal change in categorization of participants from either category.