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Achilles tendon thickness, ultrasound signs and symptoms in skaters, gymnasts, elite soccer players, club athletes and healthy sedentary adults - a cross-sectional study
  1. M Perry,
  2. D Morrissey,
  3. C Emerson,
  4. R Teatino,
  5. Z Shaikh,
  6. S Mitchell,
  7. G O'Driscoll,
  8. M Ahmad,
  9. N Maffulli
  1. Centre For Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK


Background Little is known about differences between various sports in terms of Achilles tendon pathology and ultrasonographic (US) findings. An improved knowledge of these differences may help to shed light on possible aetiological factors and guide multi-sport sports medicine support.

Aim The aim of this study was to compare Achilles tendon pathology, ultrasound signs and mid-tendon thickness between healthy sedentary controls, gymnasts, skaters, athletes and soccer players.

Methodology 111 controls, 40 elite gymnasts/tumblers, 17 elite skaters, 25 elite soccer players and 25 club athletes of mean (SD) age 21.7 (10) years were recruited. The existence of lifetime and present Achilles tendon symptoms were recorded. Mid tendon longitudinal thickness, hypoechoic areas and neovascularisation were determined with high-resolution ultrasound. χ2 tests were used to compare sports groups for pathology and US signs, and ANCOVA for tendon morphology.

Results Both tendons from each participant were included in the analysis. Groups differed in terms of the existence of present symptoms (p<0.001), symptoms ever (p<0.001), hypoechoic areas (p<0.001) and neovascularity (p<0.001). After adjustment for gender, age, lifetime Achilles pathology, height and weight, the groups also differed (p<0.001) in mid tendon thickness (table 1). Posthoc tests showed significant differences in thickness between tendons of controls and gymnasts, controls and soccer players, gymnasts and skaters, gymnasts and athletes, soccer players and skaters, and soccer players and athletes.

Conclusion There were considerable intersport differences in Achilles tendon pathology and ultrasound findings. Gymnastics, athletics and soccer appeared to have higher risk of Achilles tendinopathy symptoms and ultrasound signs than skaters and controls, implying more vigilance in these sports. Gymnasts and soccer players also have greater tendon thickness, which may be related to greater pathology as all participants with present symptoms had greater tendon thickness (p=0.04).

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