Ultrasound Screening of Achilles Tendon, Patellar Tendon, and Plantar Fascia for Pain Development in Collegiate Athletes: A Multi-institutional Prospective Evaluation

Background: Diagnostic ultrasound can evaluate musculoskeletal structures for abnormalities that correlate with tendinopathy and fasciopathy. Previous literature suggests that sonographic screening of tendons and fascia can identify structures that are at risk for developing pain, although this has not been evaluated in collegiate athletes competing in a variety of sports.

Purpose: To evaluate the use of ultrasound for screening the patellar tendon, Achilles tendon, and plantar fascia for time-loss injury in collegiate athletes during a full year.

Study design: Cohort study; Level of evidence, 2.

Methods: A total of 242 National Collegiate Athletic Association (NCAA) Division I athletes from 3 institutions participated in this yearlong prospective observational study. Each athlete completed a brief demographic questionnaire, followed by an ultrasound examination of the bilateral patellar tendons, Achilles tendons, and plantar fascia performed at the beginning of the season. Ultrasound examinations assessed for tendon/fascia thickening, hypoechogenicity, and neovascularization. Athletes were monitored for any time-loss injury in these 3 structures throughout a full year.

Results: Of the 242 athletes (n = 484 tendon/fascia) evaluated, the patellar tendon had the highest prevalence of sonographic abnormalities (37.4%), followed by the Achilles tendon (10.6%); plantar fascia abnormalities were rare (3.5%). The overall number of tendon/fascia structures that developed injury was low (<5%). The relative risk for a time-loss injury based on an initial abnormal ultrasound screening was 8.8, 17.2, and 13.2 for the patellar tendon, Achilles tendon, and plantar fascia, respectively (P < .01). Negative predictive values (99-99.6) far outweighed positive predictive values (10.3-14).

Conclusion: NCAA Division I student-athletes with sonographic abnormalities on initial screening were more likely to develop a time-loss injury in the affected tendon/fascia during the competitive season. Further research on this topic should focus on identifying the specific sonographic abnormalities and their relationship with future injury.