# The Natural History of the Development and Resolution of Achilles and Patellar Tendon Sonographic Abnormalities in a Collegiate Cohort

## TL;DR

This study tracked changes in Achilles and patellar tendons of collegiate athletes over a year and found that most sonographic abnormalities remained stable, with few new cases appearing.

## Contribution

The study provides new longitudinal data on the natural history of tendon sonographic abnormalities in collegiate athletes.

## Key findings

- Most patellar and Achilles tendons with initial abnormalities remained abnormal after one year.
- Only one Achilles tendon showed regression from abnormal to normal, with no hypoechogenicity or thickening.
- A small number of initially normal tendons developed new abnormalities, all asymptomatic.

## Abstract

Purpose: To prospectively identify the development and regression of Achilles and patellar sonographic abnormalities in collegiate athletes.

Methods: Prior to the beginning of their seasons, the Achilles and patellar tendons of collegiate athletes were sonographically videoed by an experienced sonographer. Subjects were then re-recorded at the end of 1 year of competition in an identical manner. Measurements were obtained using consistent predetermined protocols for each participant. Videos of the results were assessed in a blinded manner for echogenicity, tendon thickening, and neovascularization.

Results: A total of 147 patellar and 148 Achilles tendons were recorded, with 40.1% of patellar and 16.2% of Achilles tendons identified to have abnormalities at baseline. Of all tendons analyzed, zero patellar and one Achilles tendon were transformed from “abnormal” to “normal”—this single tendon showed only a single neovessel without hypoechogenicity or thickening. Of all tendons initially categorized as “normal,” only 4 patellar tendons switched categories to “abnormal” by the second scan, all with new hypoechogenic foci. Amongst these, all participants were asymptomatic.

Conclusions: This prospective study demonstrated that all Achilles and patellar tendons with sonographic abnormalities remain abnormal after 1 year of training and competition, with the exception of a single neovessel on one Achilles tendon that disappeared. A small percentage of collegiate student-athletes developed new abnormalities over a year of practice and competition. This may refute the idea that tendinosis comes and goes in this athletic population, given the minimal change in categorization of participants from either category.