Two‐year ultrasound follow‐up of patellar tendon, Achilles tendon and plantar fascia in collegiate athletes: Persistence of sonographic abnormalities and symptom development

PURPOSE: To prospectively evaluate sonographic changes of the Achilles tendon, patellar tendon, and plantar fascia in a cohort of collegiate athletes over multiple seasons. METHODS: Longitudinal sonographic assessment was conducted in a cohort of National Collegiate Athletic Association Division I collegiate athletes. Experienced sonographers captured videos of bilateral Achilles tendons, patellar tendons, and plantar fascia during annual preparticipation examinations, then repeated the imaging at 1- and 2-year intervals in an identical manner. Videos were then analyzed in a blinded manner, assessing for abnormalities in echogenicity, tendon thickening, and neovascularization. Athletes also reported pain at the time of the assessment and any injuries experienced. RESULTS: A total of 22 athletes (44 patellar tendons, 44 Achilles tendons, 44 plantar fasciae) 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. No tendons or fasciae with abnormalities returned to normal over 2 years, and three tendons (all Achilles) transitioned from a normal to abnormal sonographic appearance, each with associated pain development. CONCLUSIONS: This prospective study demonstrated that any baseline sonographic abnormality of the Achilles tendon, patellar tendon, and plantar fascia identified in this small cohort of collegiate athletes remained abnormal over 2 years. Additionally, only three new abnormalities in the Achilles tendon developed, each associated with symptoms. These findings challenge the idea that ultrasound-detected abnormalities suggestive of tendinopathy are transient and fluctuate in this athletic population.