title: Sonoelastography of the Achilles Tendon: Prevalence and Prognostic Value Among Asymptomatic Elite Australian Rules Football Players.
abstract: OBJECTIVE
  To investigate the prevalence of sonographic abnormalities at the mid-Achilles tendon among a cohort of asymptomatic professional football players and to determine whether these sonographic abnormalities predict midportion Achilles tendon symptoms.
  
  
  METHODS
  Longitudinal study.
  
  
  METHODS
  A single competitive season in the Australian Rules Football League.
  
  
  METHODS
  Forty-two elite Australian Rules football players.
  
  
  METHODS
  Using ultrasound and sonoelastography, 42 players were examined at baseline and again 9 months later (postseason) for the existence of intratendinous hypoechogenicity, delamination, softening, and neovascularization. The anterio-posterior (AP) thickness and cross-sectional area (CSA) were measured. Players reporting Achilles tendon pain or with Victorian Institute of Sports Assessment-Achilles scores below 80 at the end of the season were classified as symptomatic.
  
  
  RESULTS
  At preseason, ultrasound and/or sonoelastographic abnormalities were found in 22 (22/42, 52.4%) asymptomatic players. Baseline AP thickness and CSA were significantly greater in symptomatic players at the end season than those in asymptomatic players (0.57 ± 0.05 cm vs 0.50 ± 0.03 cm; P < 0.001 and 0.67 ± 0.07 cm vs 0.57 ± 0.06 cm; P < 0.001, respectively). The presence of intratendinous softening and delaminations at baseline was associated with pain onset during the season (P = 0.046; P = 0.048, respectively).
  
  
  CONCLUSIONS
  Ultrasound and sonoelastography-detected abnormalities were relatively common among the asymptomatic footballers. Greater AP thickness and CSA and also the presence of intratendinous softening and delaminations were associated with the increased risk of developing symptoms.
  
  
  CONCLUSIONS
  Conventional ultrasound supplement with sonoelastography may be able to identify elite athletes at risk of Achilles tendon injury, which may, in turn, impact therapeutic decisions.
authors.affiliation: *Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, VIC, Australia; †Department of Diagnostic Radiology, Singapore General Hospital, Singapore; ‡Imaging at Olympic Park, Melbourne, VIC, Australia; §Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary, University of London, London, United Kingdom; ¶Division of Physiotherapy, The University of Queensland, Brisbane, Australia; ‖Department of Physiotherapy, The University of South Australia, Adelaide, Australia; **Saunders Sports and Spinal, Adelaide, Australia; and ††Epping Medical and Specialist Centre, Epping, VIC, Australia.
authors.forename: Chin-Chin
authors.initials: CC
authors.lastname: Ooi
authors.forename: Michal E
authors.initials: ME
authors.lastname: Schneider
authors.forename: Peter
authors.initials: P
authors.lastname: Malliaras
authors.forename: Donna
authors.initials: D
authors.lastname: Jones
authors.forename: Steve
authors.initials: S
authors.lastname: Saunders
authors.forename: Andrew
authors.initials: A
authors.lastname: McMahon
authors.forename: David
authors.initials: D
authors.lastname: Connell
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000328:Adult; D056352:Athletes; D001315:Australia; D054459:Elasticity Imaging Techniques; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012916:Soccer / Q000293:injuries*; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult