Natural History of the Development and Resolution of Achilles Tendon, Patellar Tendon, and Plantar Fascia Sonographic Abnormalities over Two Years in a Collegiate Athlete Cohort.

Background and/or Objectives: It has previously been theorized that tendinosis comes and goes in the adult population. The objective of this prospective study was to monitor the sonographic appearance of various structures in a collegiate athlete population over two years, and analyze any patterns of development or regression of sonographic tendon abnormalities.

Design: Prospective cohort study.

Setting : Division 1 institution

Participants : A total of 22 collegiate athletes from a variety of sports.

Interventions: Prior to the beginning of each athlete’s season, the Achilles and patellar tendons, as well as plantar fasciae of collegiate athletes were sonographically videoed by an experienced sonographer. Subjects were then re-recorded at the end of one year and two years of competition in an identical manner. Measurements were obtained using consistent pre-determined protocols for each participant. Videos of the results were assessed in a blinded manner for echogenicity, tendon thickening, and neovascularization.

Main Outcome Measures: After the completion of data collection, all images were reviewed and any patterns of development or regression of sonographic abnormalities were analyzed.

Results: A total of 22 athletes (44 tendons) 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. Zero tendons with abnormalities reverted to normal and three tendons (all Achilles) progressed from normal to abnormal over the 2 year timeframe.

Conclusions: This prospective study demonstrated that all Achilles and patellar tendons and plantar fasciae with sonographic abnormalities remained abnormal after two years of training and competition. A small percentage of collegiate student-athletes developed new abnormalities in the Achilles tendon over two years of practice and competition. This may refute the idea that tendinosis fluctuates in this athletic population, given the minimal change in categorization of participants from either category.