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. 2021 Nov;49(4):410-419.
doi: 10.1080/00913847.2020.1847004. Epub 2020 Nov 26.

Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners

Daniel M Cushman  1 , Ziva Petrin  2 , Sarah Eby  1 , Nathan D Clements  3 , Peter Haight  4 , Brian Snitily  5 , Masaru Teramoto  1
Affiliations

Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners

Daniel M Cushman et al. Phys Sportsmed. 2021 Nov.

Abstract

Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.

Keywords: Sonography; overuse; primary prevention; runners; tendinopathy; ultrasonography.

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Figures

Figure 1 –
Figure 1 –
Demonstration of tendon findings. A) Normal patellar tendon. B) Normal Achilles tendon at insertion. C) Hypoechogenicity and thickening on right side of image. D) Paratenon blurring seen at superficial portion of tendon. E) Delamination seen within middle of tendon. F) Intratendinous calcification.
Figure 2a -
Figure 2a -
Cox proportional hazards regression model for development of pain in the Achilles tendon.
Figure 2b -
Figure 2b -
Cox proportional hazards regression model for development of pain in the patellar tendon.
See this image and copyright information in PMC

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