One-Year Follow-Up of Clinical and Morphological Outcomes in Elite Athletes With Early-Stage Lower Extremity Tendinopathy

Abstract

Little is known about early tendinopathy in elite athletes. This study aimed to investigate changes in clinical and ultrasonography outcomes over 1 year and assess the prognostic values of these outcomes at baseline with respect to tendinopathy progression. Sixty-two elite athletes (24 ± 5 years) with early phase (symptom duration < three months) Achilles or patellar tendinopathy (AT and PT) were examined at baseline and after one year. Pain-guided activity modification was the only intervention. Clinical outcomes were assessed using Victorian Institute of Sports Assessment questionnaires (VISA) for function and symptoms, pain scores (1–10 numerical rating scale (NRS)) and ultrasound tendon morphology (thickness, echogenicity and power Doppler (PD) flow area). A linear mixed-effects model analysed changes from baseline to 1 year. Athletes showed clinical improvements in VISA-Achilles (baseline: 66 ± 5 vs. one-year: 87 ± 2, 95% CI: 13–30, p < 0.0001 and effect size d = 3.8), VISA-Patella (baseline: 69 ± 3 vs. one-year: 86 ± 1, 95% CI: 10–26, p < 0.0001 and effect size d = 3.6) scores and most NRS pain scores (≥ 2 points). Tendinopathic Achilles tendons' peritendinous thickness was reduced (−0.79 mm, p = 0.0188 and effect size d = 0.5), whereas patellar tendons remained enlarged. For both AT and PT, lower baseline PD was associated with a greater reduction in thickness over time (p < 0.001) and higher baseline VISA scores were linked to greater increases in echo intensity over time (p = 0.0363). In conclusion, elite athletes with early phase AT and PT showed clinical improvement over 1 year, with morphological changes in tendinopathic Achilles tendons only. Lower baseline PD and better initial VISA scores represent a better prognosis for tendinopathy morphology and symptoms.