Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Abstract

Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre‐course using UTC to capture the structure of four echo‐type fibers (I–IV). All injuries were assessed by military physicians pre‐course and throughout the 14‐week course. Soldiers who were injured during the course had a significantly higher pre‐course prevalence of AT and PT echo‐type III and echo‐type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non‐injured participants were echo‐type III + IV of the PT (OR = 1.44, 95% CI = 1.24‐1.68) and echo‐type III of the AT (OR = 1.69, 95% CI = 1.35‐2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo‐type III + IV > 10% or AT echo‐type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high‐intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high‐level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At‐risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.

Intra- and Inter-Rater Reliability of Processing Ultrasound Tissue Characterization Scans in Midportion Achilles Tendinopathy

“…In clinical practice, physical data acquisition over time, combined with short-term variations in tendon architecture, may introduce additional unexplained variability. Moreover, our ICCs may be of limited generalizability to the assessment of asymptomatic Achilles tendons, as UTC is used to evaluate load [ 19 , 20 ] or sometimes to predict injury [ 36 ] in asymptomatic subjects. Finally, our results may also be of limited generalizability to the female population, since only 2 out of 50 service members were female.…”

Poor association between tendon structure and self-reported symptoms following conservative management in active soldiers with mid-portion Achilles tendinopathy

“…Based on prior research,8 10 11 for sample size calculation we assumed a low correlation of .45 between UTC and VISA-A scores 17. With a default alpha of .05 and a statistical power of .80, a sample size of 36 participants was calculated.…”

“…Combined echo-types I+II represent aligned fibrillar structure, whereas echo-types III+IV can be seen as disorganised tendon structure. UTC can be used to monitor load9 10 or to evaluate treatment 11 12…”

“…While growing evidence indicates that tendon structure should not be used to explain the presence or severity of current and future symptoms in AT, the evidence is still conflicting 8 10–13. With regard to the clinical applicability of UTC, we aimed to determine the association between pain and function, relative to the mid-portion Achilles tendon structure, in soldiers treated with a conservative treatment programme for mid-AT.…”

Victorian Institute of Sport Assessment—Achilles thresholds for minimal important change and return to presymptom activity level in active soldiers with mid-portion Achilles tendinopathy

“…In the general population, up to 60% reports pain after 5 years of follow-up,6 and 37% still experiences some level of pain and reduced function after 10 years of follow-up 4. Mid-AT is also very common among soldiers and can have a profound impact on physical activity levels and military operational readiness 7 8. A previous diagnosis of tendinopathy is considered the strongest risk factor for mid-AT 2 7…”