Ultrasound as a predictor of time-loss injury for the patellar tendon, Achilles tendon and plantar fascia in division I collegiate athletes

Objectives Tendinopathy and fasciopathy are common conditions that can result in time-loss injury in athletes. This study aimed to determine if preseason sonographic abnormalities of the patellar tendon, Achilles tendon and plantar fascia are associated with future time-loss injuries in collegiate athletes. Methods National Collegiate Athletic Association Division I athletes from three institutions participated in this 3-year prospective, observational study. Each athlete completed a questionnaire, self-reporting current and prior symptoms and underwent an ultrasound examination of bilateral patellar tendons, Achilles tendons and plantar fasciae during annual preseason examinations. Ultrasound evaluations assessed for tendon and fascia thickening, hypoechogenicity and neovascularisation. Athletes were monitored for time-loss injury over the subsequent year. Results A total of 695 athletes across 18 sporting disciplines (61.1% female, age 20.0±1.6, body mass index 23.1±2.9 kg/m2) were analysed over 3 years. Sonographic abnormalities were identified in 36.6%, 7.5% and 2.8% of the patellar tendons, Achilles tendons and plantar fasciae, respectively. Injuries were reported in 3.3%, 1.6% and 0.7% of these structures with an adjusted relative risk of injury increased by 8.9 (95% CI 3.7, 21.4), 18.8 (95% CI 7.2, 48.8) and 21.0 (95% CI 6.4, 68.1) times in those with preseason ultrasound abnormalities (p<0.001). The presence of an ultrasound abnormality was more predictive of future injury than self-report of a prior injury or pain in the area at the time of the scan. Conclusion Preseason sonographic abnormalities of the patellar tendon, Achilles tendon or plantar fascia are associated with a higher risk of developing time-loss injuries in collegiate athletes. Data are available on reasonable request.