Patellar Tendon Structural Difference Occurs in Female and Male Professional Basketball Players: 8 Months Follow-Up

<b>Background:</b> Tendon structure is related to the magnitude of load and its management, rather than directly predicting pain incidence. Although pain symptoms frequently persist until they severely impact performance, function, and tendon structure, professional basketball players often manage patellar tendon pain alongside high training and competition loads. The aim of this study was to investigate patellar tendon structural adaptations over 8 months of training and competition in professional female and male basketball players. <b>Methods:</b> The primary outcome of this study was defined as the change in the percentage of echo-type II structure from baseline to 8 months. A prospective cohort study was conducted where 43 professional basketball players (20 male, 23 female) were followed during 8 months of training and competition. A bilateral patellar tendon ultrasound tissue characterization (UTC) scan was conducted, and jumping leg (jumping/non-jumping), presence of pain (yes/no), and exposure time (hours) were recorded at baseline, and at 4 and 8 months in the competitive season. <b>Results:</b> The mid-tendon exhibited negative adaptations (decreased alignment), represented by echo-type II, after 8 months of competition (left; <i>p</i> = 0.001; ES = 2.16; right; <i>p</i> = 0.001; ES = -1.35). Positive adaptations (increased alignment], were observed in echo-types III (<i>p</i> = 0.004; ES = -1.04) and IV (<i>p</i> = 0.001; ES = -0.15), after 4 and 8 months. Tendon structure showed differences between female and male professional basketball players throughout the 8 months (echo-type II; <i>p</i> = 0.00; ES = 0.34). <b>Conclusions:</b> The study demonstrated that the tendon structure undergoes significant adaptations, supporting the concept that the patellar tendon adapts to compensate for areas of structure disorganization. Female professional basketball players appeared to maintain a more organized tendon structure than their male counterparts. Jumping leg and presence of pain did not show significant differences in tendon structure over the study period. This research has significant implications for elite sport, as a better understanding of tendon load capacity throughout a competitive season is needed.