Abstract
PurposeChanges in tendon structure are commonly seen in patients with unilateral achilles (AT) or patellar (PT) tendinopathy but might also be present on the asymptomatic side, indicating a higher risk for developing symptoms. The aim of this study is to compare tendon structure of the symptomatic side with the asymptomatic side in AT and PT patients and control subjects.MethodsA total of 46 patients with unilateral AT (16 insertional and 30 midportion) and 38 with unilateral PT were included. For the control group, a total of 18 Achilles tendons and 25 patellar tendons were scanned. Tendon structure was assessed using ultrasound tissue characterisation (UTC), which quantifies tendon organisation dividing the structure into four different echo types (I–IV).ResultsThere were significant differences in echo types I, III, and IV between symptomatic and asymptomatic sides and controls. Additionally, there was a significant difference between the symptomatic and the asymptomatic side for all tendinopathy locations. In the insertional AT tendon portion, the symptomatic side showed a higher percentage of echo type III. For the midportion AT, the symptomatic side showed a lower percentage of echo type I and a higher percentage of echo types III and IV. For the patellar tendon, the symptomatic side showed a higher percentage of echo types III and IV. All differences were higher than the minimal detectable changes.ConclusionAlthough patients have symptoms unilaterally, the tendon structures are compromised on both sides. These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice.Level of evidenceIII.
Highlights
Tendinopathy is a common injury that causes pain and functional limitations [19] and leads patients to seek medical attention
The diagnoses of AT and PT are based mainly on clinical examination [18, 25], imaging might be used to exclude other musculoskeletal disorders or to help clinicians with their treatment decision [20]. It is well-known that imaging abnormalities are present in tendons diagnosed with tendinopathy [7, 37]
None of the patients included in this study reported previous complaints in the asymptomatic side
Summary
Tendinopathy is a common injury that causes pain and functional limitations [19] and leads patients to seek medical attention. The diagnoses of AT and PT are based mainly on clinical examination [18, 25], imaging might be used to exclude other musculoskeletal disorders or to help clinicians with their treatment decision [20] It is well-known that imaging abnormalities are present in tendons diagnosed with tendinopathy [7, 37]. These abnormalities can be present on the asymptomatic side [7, 14, 16, 23]. Echo type I is the most stable echo pattern and echo type IV the least stable [33]
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