Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities Among 533 Division I Collegiate Athletes from a Variety of Sports.

OBJECTIVE To assess the prevalence of ultrasound-detected abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among Division I collegiate athletes and to identify associated demographic and sport-related risk factors.

DESIGN Multi-institutional, 3-year observational study.

SETTING Preseason screening evaluations conducted at collegiate athletic programs.

PATIENTS A total of 533 Division I collegiate athletes representing 18 sports.

INTERVENTIONS All participants underwent ultrasound imaging of bilateral patellar tendons, Achilles tendons, and plantar fasciae. Abnormalities were defined as the presence of hypoechogenicity, morphologic thickening, or neovascularity.

MAIN OUTCOME MEASURES Prevalence of sonographic abnormalities and their association with demographic and sport-specific variables, along with the presence or absence of symptoms at the time of scanning.

RESULTS The highest prevalence of abnormalities was observed in the patellar tendon (36.1%), followed by the Achilles tendon (7.1%) and plantar fascia (2.4%). Most abnormalities were asymptomatic, although athletes with abnormalities were significantly more likely to report current pain. Older age was associated with increased risk of Achilles tendon and plantar fascia abnormalities, while male sex and participation in explosive or running sports were linked to higher prevalence of patellar tendon abnormalities.

CONCLUSIONS This study represents the largest known assessment of tendon and fascia ultrasound abnormalities in a collegiate athlete cohort. Findings support the use of ultrasound as an accessible, real-time diagnostic tool for early identification of subclinical pathology, which may allow for targeted interventions aimed at reducing time-loss injuries and optimizing long-term athlete health.