title: Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis.
abstract: BACKGROUND
  Ultrasound (US) imaging is commonly used to visualise tendon structure. It is not clear whether the presence of structural abnormalities in asymptomatic tendons predicts the development of future tendon symptoms in the Achilles or patellar tendon.
  
  
  OBJECTIVE
  To perform a systematic review and meta-analysis investigating the ability of US imaging to predict future symptoms of patellar or Achilles tendinopathy.
  
  
  METHODS
  Prospective studies that performed US imaging of Achilles OR patellar tendon structure among asymptomatic patients at baseline and a clinical measure of pain and/or function at follow-up were included. Study quality was assessed using the Critical Appraisal Skills Programme tool by two independent reviewers, and predictive ability of US was assessed using meta-analyses.
  
  
  RESULTS
  The majority of participants in the review were from sporting populations. Meta-analysis revealed that tendon abnormalities on US are associated with future symptoms of both patellar and Achilles tendinopathy (RR=4.97, 95% CI 3.20 to 7.73). Subgroup analysis indicated that tendon abnormalities at baseline were associated with an increased risk of both Achilles (RR=7.33, 95% CI 2.95 to 18.24) and patellar (RR=4.35, 95% CI 2.62 to 7.23) tendinopathy.
  
  
  CONCLUSIONS
  This systematic review and meta-analysis indicates that tendon abnormalities visualised using US in asymptomatic tendons are predictive of future tendinopathy and are associated with at least a fourfold increased risk.
  
  
  CONCLUSIONS
  Identification of at-risk athletes using screening tools such as US may allow preventative programmes to be implemented. However, it is clear that other factors beyond tissue structure are involved in the development of lower limb tendinopathy.
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Seán
authors.initials: S
authors.lastname: McAuliffe
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Karen
authors.initials: K
authors.lastname: McCreesh
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Culloty
authors.affiliation: Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland.
authors.forename: Helen
authors.initials: H
authors.lastname: Purtill
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Kieran
authors.initials: K
authors.lastname: O'Sullivan
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017847:Patellar Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Achilles tendon; Injury prevention; Tendinopathy; Ultrasound