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1 The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue + 527 word(s) 527 2020-08-05 11:34:25 |
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Sánchez Romero, E.A.; Pollet, J.; Martín Pérez, S.; Alonso Pérez, J.L.; Muñoz Fernández, A.C.; Pedersini, P.; Barragán Carballar, C.; Villafañe, J.H. Tendinopathy. Encyclopedia. Available online: (accessed on 28 November 2023).
Sánchez Romero EA, Pollet J, Martín Pérez S, Alonso Pérez JL, Muñoz Fernández AC, Pedersini P, et al. Tendinopathy. Encyclopedia. Available at: Accessed November 28, 2023.
Sánchez Romero, Eleuterio A., Joel Pollet, Sebastián Martín Pérez, José Luis Alonso Pérez, Alberto Carlos Muñoz Fernández, Paolo Pedersini, Carlos Barragán Carballar, Jorge Hugo Villafañe. "Tendinopathy" Encyclopedia, (accessed November 28, 2023).
Sánchez Romero, E.A., Pollet, J., Martín Pérez, S., Alonso Pérez, J.L., Muñoz Fernández, A.C., Pedersini, P., Barragán Carballar, C., & Villafañe, J.H.(2020, August 28). Tendinopathy. In Encyclopedia.
Sánchez Romero, Eleuterio A., et al. "Tendinopathy." Encyclopedia. Web. 28 August, 2020.

Using three different databases—PubMed, MEDLINE and CENTRAL—a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results.

Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages.

Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted.

tendinopathy ultrasonography reliability

1. Introduction

Soft tissue injuries of the lower limb are widely diffuse and put a significant financial burden on the health care systems worldwide. Tendinopathy is a common problem in the adult population that especially affects elite athletes and amateurs. The prevalence of tendinopathies in sporting people is 22%, with differences related to sport and to the level[1]. Patellar tendinopathy, one of the commonest tendinopathy, afflicts the 45% of elite volleyball players and the 32% of elite basketball players[2], in elite soccer players, cumulative trauma disorder and re-injuries constituted 37% and 22% of all injuries[3], while among non-elite players of all the different sports, the incidence is lower, only 14%, but still remarkable[4]. While the prevalence in elite athletes of the Achilles tendinopathy is 5%, and rises till 9% in recreational runners[5]. Quadriceps tendinopathy prevalence is about 14.2% of elite athletes, especially in sports that require repetitive jumps[2]. Proximal Hamstring Tendinopathy and Gluteus tendinopathy are most common among distance runners and athletes performing, but their prevalence is still nuclear[6][7].

Abnormal kinematics and the overuse of the tendon have been implicated as the major risk factors for lower limb tendinopathy, even if the amount of loading that generates the pathology is still not clear[8][9]. Overuse is a key factor from 30% to 50% of all sporting injuries and the incidence has raised in recent decades, likely due to the growing involvement on athletes and greater demands in running and recreational sports. For what concerns the pathogenesis, different theories have been proposed[10]: (i) degenerative theory proposes that overloading causes changes in tendon cells and degeneration of the matrix[11]; (ii) failed healing theory suggests that, at the early stage of tendinopathy, a healing process that increases the production of protein is ongoing and causes a disorganisation of the matrix[12][13]; (iii) unloading theory suggests that not only overloading causes the changes in the cell and matrix of the tendon, but also unloading[14]; (iv) the last and widely accepted theory is the continuum theory, in which tendon pathology is composed by three stages (reactive tendinopathy, tendon disrepair and degenerative tendinopathy) in continuity between them[15].

2. Influences

Ultrasound is a reliable, non-invasive and cost-effective imaging tool to assist the clinical diagnose of a tendinopathy. It is effective in the differentiation between a heathy tendon and an abnormal tendon; , but new techniques like UTC gave encouraging results for this process. Moreover, recently ultrasound has been combined with some treatments to guide the localization of the treatment only to the abnormal area of the tendon. Results are encouraging, but further research should investigate some of these techniques with high-quality studies.


  1. Daniel Florit; Carles Pedret; Martí Casals; Peter Malliaras; Dai Sugimoto; Gil Rodas; Incidence of Tendinopathy in Team Sports in a Multidisciplinary Sports Club Over 8 Seasons. null 2019, 18, 780-788, .
  2. Østein B. Lian; Lars Engebretsen; R. Bahr; Prevalence of Jumper's Knee among Elite Athletes from Different Sports: A Cross-sectional Study. The American Journal of Sports Medicine 2005, 33, 561-567, 10.1177/0363546504270454.
  3. Markus Waldén; Martin Hägglund; Jan Ekstrand; Injuries in Swedish elite football-a prospective study on injury definitions, risk for injury and injury pattern during 2001. Scandinavian Journal of Medicine & Science in Sports 2005, 15, 118-125, 10.1111/j.1600-0838.2004.00393.x.
  4. Johannes Zwerver; Steven W. Bredeweg; Inge Van Den Akker-Scheek; Prevalence of Jumper’s Knee Among Nonelite Athletes From Different Sports. The American Journal of Sports Medicine 2011, 39, 1984-1988, 10.1177/0363546511413370.
  5. Jack Lysholm; Jorgen Wiklander; Injuries in runners. The American Journal of Sports Medicine 1987, 15, 168-171, 10.1177/036354658701500213.
  6. Goom, T.S.; Malliaras, P.; Reiman, M.P.; Purdam, C.R. Proximal hamstring tendinopathy: Clinical aspects of assessment and management. J. Orthop. Sports Phys. Ther. 2016, 46, 483–493.
  7. Grimaldi, A.; Fearon, A. Gluteal tendinopathy: Integrating pathomechanics and clinical features in its management. J. Orthop. Sports Phys. Ther. 2015, 45, 910–922.
  8. Boesen, A.P.; Hansen, R.; Boesen, M.I.; Malliaras, P.; Langberg, H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion achilles tendinopathy: A randomized double-blinded prospective study. Am. J. Sports Med. 2017, 45, 2034–2043.
  9. Mousavi, S.H.; Hijmans, J.M.; Rajabi, R.; Diercks, R.; Zwerver, J.; van der Worp, H. Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis. Gait Posture 2019, 69, 13–24.
  10. Zafar Ahmad; Asif Parkar; Jennifer Shepherd; Neil Rushton; Revolving doors of tendinopathy: definition, pathogenesis and treatment. Postgraduate Medical Journal 2019, 96, 94-101, 10.1136/postgradmedj-2019-136786.
  11. L. Józsa; P. Kannus; Histopathological findings in spontaneous tendon ruptures.. Scandinavian Journal of Medicine & Science in Sports 1997, 7, 113-118, 10.1111/j.1600-0838.1997.tb00127.x.
  12. Kraushaar, B.S.; Nirschl, R.P. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J. Bone Jt. Surg. Am. 1999, 81, 259–278.
  13. Cook, J.L.; Purdam, C.R. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br. J. Sports Med. 2009, 43, 409–416.
  14. Keitaro Kubo; H Akima; J Ushiyama; I Tabata; H Fukuoka; H Kanehisa; T Fukunaga; Effects of 20 days of bed rest on the viscoelastic properties of tendon structures in lower limb muscles. British Journal of Sports Medicine 2004, 38, 324-330, 10.1136/bjsm.2003.005595.
  15. Jill L. Cook; E Rio; C R Purdam; Sean I. Docking; Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. British Journal of Sports Medicine 2016, 50, 1187-1191, 10.1136/bjsports-2015-095422.
Subjects: Sport Sciences
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Update Date: 28 Aug 2020