Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy

Review written by Dr Ebonie Rio info

Key Points

  1. In people with tendinopathy on one side, there are often changes on the other side too.
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Tendinopathy is described as tendon pain and dysfunction. Imaging changes are present in those diagnosed with tendinopathy, however these abnormalities have been found in asymptomatic tendons, as well as in patients who have no history of tendon pain (controls) (1,2).

Ultrasound tissue characterization (UTC) captures a 3D image of the tendon and uses standardized parameters to quantify the consistency and intensity of gray levels within the image. Echo type 1 describes the most stability of pixel brightness (meaning the fibres are aligned and the beam can bounce off and reflect) while Echo type 4 describes the least stable image (more disorganization). These echo types correlate with the degree of structural similarity within a specific tendon volume (2).

The aim of this study was to compare tendon structure of the symptomatic side with the asymptomatic side in Achilles tendinopathy (AT) and patellar tendinopathy (PT) patients, and to also compare them with controls.

Imaging changes are present in those diagnosed with tendinopathy.
Grade strength and load for each side individually when managing unilateral tendinopathy.


151 patients with Achilles or patellar tendon complaints were reviewed at a clinic specializing in tendons. Inclusion required patients to have unilateral insertion or midportion AT and or PT, for a period greater than 3 months. Those who had sought

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