Prognostic value of Achilles tendon Doppler sonography in asymptomatic runners

Med Sci Sports Exerc. 2012 Feb;44(2):199-205. doi: 10.1249/MSS.0b013e31822b7318.


Introduction: Midportion Achilles tendinopathy (MPT) is a common problem in running athletes. Nevertheless, its etiology is not fully understood, and no valid prognostic criterion to predict the development of MPT could be identified to date. The purpose of the present study, therefore, was to evaluate whether power Doppler ultrasonography (PDU) is a suitable method to identify a predisposition to MPT in yet asymptomatic runners.

Methods: At 23 major running events, 634 asymptomatic long-distance runners were tested for Achilles tendon thickness, vascularization, and structural abnormalities using a high-resolution PDU device (Toshiba Aplio SSA-770A/80, 12 MHz). In addition, their medical history and anthropometric data were documented. All subjects were contacted 6 and 12 months later and asked about any new symptoms. The collected anamnestic, anthropometric, and ultrasonographic data were subjected to regression analysis to determine their predictive value concerning the manifestation of midportion Achilles tendon complaints (P < 0.05).

Results: The highest odds ratio (OR) for manifestation of MPT within 1 yr was found for intratendinous blood flow ("neovascularization," OR = 6.9, P < 0.001). An increased risk was also identified for subjects with a positive history of Achilles tendon complaints (OR = 3.8, P < 0.001). A third relevant parameter, just above the level of significance, was a spindle-shaped thickening of the tendon on PDU (Wald χ2 = 3.42).

Conclusions: PDU detection of intratendinous microvessels in the Achilles tendons of healthy runners seems to be a prognostically relevant factor concerning the manifestation of symptomatic MPT. This finding lays the foundation for an early identification of a predisposition to MPT as well as prophylactic intervention in as yet asymptomatic runners.

Publication types

  • Clinical Trial

MeSH terms

  • Achilles Tendon / abnormalities
  • Achilles Tendon / anatomy & histology
  • Achilles Tendon / blood supply
  • Achilles Tendon / diagnostic imaging*
  • Adolescent
  • Adult
  • Aged
  • Athletes*
  • Athletic Injuries / diagnostic imaging*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neovascularization, Physiologic
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Running*
  • Tendinopathy / diagnostic imaging*
  • Ultrasonography, Doppler / instrumentation*
  • Ultrasonography, Doppler / methods
  • Young Adult