Two-year ultrasound follow-up of patellar tendon, Achilles tendon and plantar fascia in collegiate athletes: Persistence of sonographic abnormalities and symptom development.

Abstract

Purpose To prospectively evaluate sonographic changes of the Achilles tendon, patellar tendon, and plantar fascia in a cohort of collegiate athletes over multiple seasons. Methods Longitudinal sonographic assessment was conducted in a cohort of National Collegiate Athletic Association Division I collegiate athletes. Experienced sonographers captured videos of bilateral Achilles tendons, patellar tendons, and plantar fascia during annual preparticipation examinations, then repeated the imaging at 1- and 2-year intervals in an identical manner. Videos were then analyzed in a blinded manner, assessing for abnormalities in echogenicity, tendon thickening, and neovascularization. Athletes also reported pain at the time of the assessment and any injuries experienced. Results A total of 22 athletes (44 patellar tendons, 44 Achilles tendons, 44 plantar fasciae) completed the study. Prevalence of abnormalities at baseline were 34.1%, 18.2%, and 6.8% for patellar tendons, Achilles tendons, and plantar fasciae, respectively. No tendons or fasciae with abnormalities returned to normal over 2 years, and three tendons (all Achilles) transitioned from a normal to abnormal sonographic appearance, each with associated pain development. Conclusions This prospective study demonstrated that any baseline sonographic abnormality of the Achilles tendon, patellar tendon, and plantar fascia identified in this small cohort of collegiate athletes remained abnormal over 2 years. Additionally, only three new abnormalities in the Achilles tendon developed, each associated with symptoms. These findings challenge the idea that ultrasound-detected abnormalities suggestive of tendinopathy are transient and fluctuate in this athletic population.