Ultrasound may help predict future tendon injuries in dancers

Asymptomatic focal hypoechoic changes in the patellar and achilles tendons moderately increase the risk for future injury in professional dancers, show study findings.

"The achilles and patellar tendons are subjected to considerable stress during many athletic endeavours. Pain and injuries involving these tendons are therefore very common among athletes, and particularly in ballet dancers, due to the unique demands of their art," say Jules Comin (Imaging @ Olympic Park, Melbourne, Australia) and colleagues.

Although changes in the achilles and patellar tendons are common in athletes, it is unclear to what extent these abnormalities are adaptive or predictors of future injury, add the authors in the British Journal of Sports Medicine.

To investigate further, the researchers recruited 79 professional ballet dancers (35 men; 44 women) working for the English National Ballet, none of whom had symptoms of tendinopathy. The dancers underwent detailed ultrasonographic imaging of both tendons and were then followed up for 24 months for incident tendon injury.

Whilst sonographic tendon abnormalities were common among the dancers, only moderate or severe focal hypoechoic changes were mildly but significantly predictive of disabling achilles or patellar tendon injury, which occurred in 10 dancers (14 tendons - seven achilles, seven patellar) over the follow-up period.

Overall, 42.8% of those with patellar and 42.8% of those with achilles tendon injury had moderate to severe hypoechoic changes in the relevant tendons at baseline compared with 10.6% and 10.6% of those who remained asymptomatic, respectively.

Other tendon abnormalities, such as differences in proximal or distal diameter, intratendon defects, calcification, and neovascularity were not predictive of tendon injury in this cohort, notes the team.

The findings suggest that "screening of asymptomatic individuals may be of use in identifying those who are at higher risk of developing tendon-related disability, which may in turn allow targeted modifications of training or other preventative regimens," write Comin et al.

"Further studies are needed to confirm predictive accuracy, and define exactly which features are the most important," they conclude.

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