Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes

Abstract

Tendons adapt in response to sports-specific loading, but sometimes develop tendinopathy. If the presence of ultrasound changes like hypoechoic areas and neovascularization in asymptomatic tendons precede (and predict) future tendon problems is unknown. The aim of this prospective cohort study was to investigate the relationship between the development of ultrasound changes in the patellar and quadriceps tendons and symptoms of jumper's knee, as well to examine the medium-term effects of intensive training on tendon thickness among adolescent athletes. Elite junior volleyball athletes were followed with semi-annual ultrasound and clinical examinations (average follow-up: 1.7 years). Of the 141 asymptomatic athletes included, 22 athletes (35 patellar tendons) developed jumper's knee. In a multivariate logistic regression analysis, a baseline finding of a hypoechoic tendon area (odds ratio 3.3, 95% confidence interval 1.1 to 9.2) increased the risk of developing symptoms of jumper's knee. Patellar tendon thickness among healthy athletes did not change (Wilk's lambda, P = 0.07) while quadriceps tendon thickness increased (P = 0.001). In conclusion, ultrasound changes at baseline were risk factors for developing symptoms of jumper's knee. Also, among healthy athletes, we observed a 7-11% increase in quadriceps tendon thickness, while there was no increase in patellar tendon thickness.

Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study

“…Patellar tendon ultrasonography is commonly performed in the routine management of athletes of different disciplines to investigate tendon abnormalities that may occur due to repetitive tendon overload [7][8][9][10] . In fact, patellar tendinopathy is a common overuse disorder typically occurring in athletes who participate in sports that require jumping, including volleyball and basketball, hence the label "jumper's knee" 11,12 .…”

Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professional “Pallapugno” Players: A Texture-Based Ultrasound Approach

“…Ultrasound imaging of the patellar tendon is commonly employed to study tendon abnormalities that could occur because of repetitive overload, which is a common happening in professional athletes of various disciplines [10][11][12][13]. Patellar tendinopathy (PT) is especially common in athletes that play sports that require jumping, such as basketball and volleyball, giving it its common-term name of "jumper's knee" [14,15].…”

“…In their study, they also conducted a morphological analysis and found that the athletes with PT had a larger painful tendon compared with the contralateral non-painful side (thickness: 6.9 ± 1.8 mm vs. 4.6 ± 0.6 mm, respectively), whereas the controls had no difference between sides (5.6 ± 1.2 mm vs. 5.3 ± 1.0 mm). Morphological abnormalities in the tendon ultrasound image, such as increased tendon thickness, neovascularization, and presence of hypoechoic areas, have also been found in a large percentage of asymptomatic athletes [9,11,13,22]. Recently, Giacchino et al [23] also conducted a study of patellar tendon size and structure in throwers and found that the prevalence of subclinical tendinopathy was high in the non-dominant patellar tendon as a possible result of the repeated non-dominant lower limb overload.…”

Relación entre estructura del pie y características del ligamento rotuliano en jugadores de voleibol

“…Otra posibilidad es que este dolor provenga de tejido no tendinoso como la articulación femoro-patelar o alguna otra estructura que de dolor referido al tendón rotuliano en cuyo caso se debe realizar un diagnóstico diferencial. Áreas hipoecoicas representan un factor de riesgo a la hora de desarrollar una tendinopatía rotuliana pero estos cambios estructurales no tienen que estar necesariamente asociados a los síntomas 191 .…”

“…Este mismo autor afirmó que el grosor estaba relacionado con el grado de afectación de las imágenes principalmente en los hombres, donde los tendones cuyas imágenes tenían una anormalidad difusa, desestructurada, eran sobre 44% más gruesos de lo normal y los tendones cuyas imágenes tenían focos anecoicos eran sobre 82% más gruesos de lo normal. Otro autor que estudió jugadores de voleibol adolescentes consideró que el punto de corte para los hombres a partir del cual tenían más posibilidad de generar tendinopatía en el futuro era de 5mm en la zona más proximal del tendón patelar, 4.6mm en la zona media y 4.4mm en la zona mas distal mientras para las mujeres los valores eran de 4.2mm, 4mm y 4.1mm respectivamente 191 . Por otra parte, este aumento de diámetro suele ir asociado con mayor dolor en atletas con tendinopatía 188,194 y puede implicar un cambio inicial en cuanto a la estructura del tendón 94,193 .…”