Structural integrity is decreased in both Achilles tendons in people with unilateral Achilles tendinopathy

J Sci Med Sport. 2015 Jul;18(4):383-7. doi: 10.1016/j.jsams.2014.06.004. Epub 2014 Jun 20.


Objectives: A high proportion of Achilles tendinopathy patients develop bilateral symptoms with human and animal studies showing bilateral histological changes associated with overuse/pathology in one tendon. The current study examined changes in tendon structure, assessed semi-quantitatively using ultrasound tissue characterisation, in both the symptomatic and asymptomatic tendon in unilateral Achilles tendinopathy patients in comparison to individuals with no history of tendinopathy.

Design: Cross-sectional case-control study.

Methods: Participants with Achilles tendinopathy (n=21), with varying severity and length of clinical symptoms, and six participants with no history of tendinopathy were recruited. Tendons were scanned using ultrasound tissue characterisation, which captures contiguous transverse ultrasound images every 0.2mm and renders a 3-dimensional image. Ultrasound tissue characterisation quantifies tendon structure by measuring the stability of echopattern over contiguous transverse images. Four echo-types were discriminated and expressed as a percentage. Antero-posterior diameter of all tendons was measured.

Results: Significant differences were observed in the proportion of normal tendon structure between all three groups (p<0.01), with the symptomatic tendon containing the least amount of normal tendon structure (symptomatic - 79.5%, asymptomatic - 81.8%, control - 86.4%). The asymptomatic tendon contained significantly less normal tendon in comparison to the control tendon (p=0.008), suggesting the asymptomatic tendon is structurally compromised despite the absence of symptoms.

Conclusions: Both Achilles tendons are structurally compromised in patients with unilateral Achilles tendinopathy. Future studies need to investigate whether these changes increase the risk of developing symptoms.

Keywords: Achilles tendon; Bilateral; Tendinopathy; UTC; Ultrasonography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achilles Tendon / diagnostic imaging*
  • Achilles Tendon / pathology
  • Adult
  • Asymptomatic Diseases
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Tendinopathy / diagnostic imaging*
  • Tendinopathy / pathology
  • Ultrasonography
  • Young Adult