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Medicina dello Sport 2022 September;75(3):436-45

DOI: 10.23736/S0025-7826.22.04170-9


language: English, Italian

Ultrasonographic evaluation of Achilles tendon and patellar enthesis in football and basketball players: could it be useful to predict muscular and tendon injuries?

Fabio M. PERROTTA 1, Mario RONGA 2, Germano GUERRA 1, Ennio LUBRANO 1

1 Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy; 2 Operative Unit of Orthopedics and Trauma, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, University of Messina, Messina, Italy


BACKGROUND: Achilles and patellar entheseal abnormalities are frequently seen in athletes and healthy subjects at ultrasound (US) evaluation. However, to our knowledge, no studies have been performed to assess the possible association between the presence of subclinical entheseal abnormalities and the possibility to develop muscular injuries in professional athletes. The aim of this study was: to compare US entheseal abnormalities in a group of athletes with age and sex-matched healthy controls and to assess the 12 months risk for the development of symptomatic muscular and tendon injuries at lower limb.
METHODS: Consecutive soccer and basket players attending our clinic for routine controls were asked to participate. US evaluation of Achilles tendon and patellar tendon insertion at tibial tuberosity was performed in order to evaluate the presence of subclinical enthesopathy. The evaluation of tendons and entheseal thickness was also performed. Finally, athletes were followed up for 1 year and the development of muscular and tendon injuries at lower limb was evaluated.
RESULTS: Forty athletes and 20 healthy controls were enrolled for this study. Overall, entheseal US abnormalities were found in 25 (62.5%) athletes. Both Achilles tendon and enthesis thickness were significantly higher in respect to healthy controls. During the follow up, 6 (15%) athletes suffered a muscle injury at lower limb and 1 (2.5%) an Achilles tendon lesion. None of the enrolled controls reported any injuries. Logistic regression analysis did not find any statistically significant associations between the presence of entheseal abnormalities and the development of injury. However, a tendency to develop muscular injuries at lower limb was found in those athletes with Achilles tendon abnormalities (odds ratio [95% CI]: 6 [0.83-43], P=0.07).
CONCLUSIONS: A tendency for an association of US Achilles tendon enthesopathy with muscular lower limb injuries was found. This may suggest that screening of asymptomatic individuals could be of use in identifying those who are at higher risk of developing injury, which may allow targeted modifications of training or other preventative regimens.

KEY WORDS: Ultrasonography; Enthesopathy; Muscles; Injuries, Athletes

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