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01-12-2020 | Research | Uitgave 1/2020 Open Access

Journal of Foot and Ankle Research 1/2020

Tendon morphological changes after a prolonged ski race can be detected by ultrasound echo intensity

Journal of Foot and Ankle Research > Uitgave 1/2020
Alessandro Schneebeli, Lorenzo Visconti, Corrado Cescon, Ron Clijsen, Guido Giardini, Maria Elisabetta Arizzio, Marco Barbero
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Ultrasound imaging techniques have been used to assess the characteristics of skeletal muscles and tendons. Such techniques (gray scale analysis) allow qualitative evaluation and have been used recently to assess the internal structure of muscles and tendons by computer-aided gray scale analysis. We hypothesized that changes in the internal structure of the Achilles and patellar tendons after a ski mountaineering race competition could be detected with ultrasound.


Twenty athletes were recruited during the 19th Millet Tour du Rutor extreme, a three-day ski mountaineering competition. Ultrasound measurements of the Achilles and patellar tendons were carried out before the first race and immediately after each of the three competition days. Tendon thickness, cross-sectional area (CSA), and ultrasound gray scale analysis were calculated.


Significant differences (p < 0.05) were observed between the pre- and post-race measurements for the Achilles tendon thickness and CSA, while no significant differences were noted for the patellar tendon thickness and CSA. However, gray scale analysis of both the Achilles and patellar tendons showed significantly higher post-race values, than the pre-race values (p < 0.05).


Achilles and patellar tendons of healthy athletes are highly responsive to an acute increase in mechanical load. Those changes can be detected from classical (thickness and CSA) and innovative (gray scale) ultrasound-based parameters.

Trial registration

This study was approved by the Azienda USL Valle d’Aosta Ethics Committee (protocol no. 23/03/2018.0026243.I).

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