Significance of Ultrasonographically Detected Asymptomatic Tendinosis in the Patellar and Achilles Tendons of Elite Soccer Players: A Longitudinal Study

Background Chronic tendinosis of the Achilles or patellar tendons, or both, is one of the most frequent and severe conditions that affects athletes in sports such as soccer. It can often end an athlete's sports activity. Hypothesis Ultrasonography of asymptomatic tendons can be used to predict which athletes will develop tendon symptoms. Study Design Longitudinal study. Methods Using ultrasonography of the ankle and knee, we examined 54 elite soccer players in the top Danish soccer league before and after a single season (in January and December). Results At the start of the season, ultrasonography had revealed abnormalities in 29% of those examined. Eighteen percent (18 of 98 tendons) were observed to have abnormal sonographic findings in the patellar tendon at the initial examination in January. These athletes were found to have a 17% risk of developing symptomatic jumper's knee during the 12-month season. Eleven percent (11 of 96 tendons) were observed to have abnormal sonographic findings in the Achilles tendon at the initial examination; it was calculated that they had a 45% risk of developing symptoms of Achilles tendinosis. Only one of the players with normal tendons in January actually developed symptoms by the end of the season. Conclusions For the first time it is now possible to identify risk factors for the development of serious tendon disorders in asymptomatic athletes. Future studies may be directed at developing preventive treatment to reduce the risk of chronic, therapy-resistant symptoms of tendinosis and ruptures.