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Are asymptomatic ultrasound abnormalities in the achilles tendon of elite soccer players risk factors for symptoms one year later? a longitudinal cohort study
  1. S Jhingan,
  2. M Perry,
  3. G O'Driscoll,
  4. M Ahmad,
  5. N Maffulli,
  6. D Morrissey
  1. Centre for Sport & Exercise Medicine, Queen Mary, University of London, London, UK


Background Achilles tendinopathy is common and can bring a sports career to a premature end. Identifying players at an increased risk of this debilitating condition could lead to better prevention.

Objectives The primary aim was to compare asymptomatic elite soccer players with and without baseline ultrasound changes in terms of development of Achilles tendinopathy symptoms at one year follow-up. This study also investigated the effect that baseline tendon thickness had on development of symptoms.

Method Using ultrasonography of the Achilles tendon, 18 initially asymptomatic elite soccer players in the top English league were examined in April 2009 and in May 2010. Symptom development during the 12 month follow-up period was assessed with an Achilles tendinopathy questionnaire on follow-up. Any Achilles pain during the follow-up period, of any duration or severity, was deemed to represent symptom development.

Results No association between the existence of baseline asymptomatic ultrasound signs and development of Achilles tendinopathy symptoms in the following year was observed (χ2, 1.180 p=0.277). Baseline calcaneal insertion thickness was greater in tendons that experienced symptoms (p=0.035) in the following year compared to those that remained asymptomatic.

Conclusion Baseline calcaneal insertion thickness was identified as a risk factor in the development of Achilles tendinopathy in elite soccer players. However, follow-up studies should aim to establish whether abnormal ultrasound signs and thickness measures over a longer period of time are significant markers of a presymptomatic stage.

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