In our team of high-level professional athletes, we are now serially UTC-scanning our ongoing Achilles and Patella tendon pathologies weekly and sometimes bi-weekly as a means of monitoring player’s ability to train and play. Patella tendons are scanned using the same settings as the Achilles, the patient is positioned supine with the hip flexed enough to achieve 90 degrees of knee flexion with the foot flat on the bed. Recently, we started to UTC-scan in injury-prone players the Quadriceps and Hamstrings too.
Despite earlier thoughts that UTC might not be sensitive enough for the detection of already minimal effects of exercise or interventions, we are certainly seeing differences even within days of implementing rest or pharmacological interventions.
There is an interesting case this week of a player who suffered an injury elsewhere that changed his running style and thus increased the load on his Patella tendon during the game. After the game, a significant focal change in the proximal Patella tendon could be observed on UTC within days, initially without clinical symptoms; these symptoms became manifest after some weeks, accompanied with increased disorganization on UTC.
Another interesting case is a patient in my clinic that I recently UTC-scanned for the second time after a week of recommended rest. Although the rest was recommended for a contralateral injury, we observed a localised change in the fiber pattern in the other, initially non-symptomatic, Achilles tendon.
The first UTC scan (Figure 1) reveals in the center of the tendon a focal area with blue pixels (echo-type II), indicative for remodeling tissue in a reactive stage caused by a temporary, reversible, exercise-effect or by persistent degeneration. One week later, the second UTC scan (Figure 2) revealed a dramatic worsening, with increased amounts of red pixels (echo-type III, generated by mainly fibrillar tissue) and black pixels (echo-type IV, generated by mainly cellular tissue and fluid), thus indicative for extensive disintegration of the tendon. On further questioning it was revealed that 48 hours earlier he had been demonstrating some movements running on sand while coaching his teammates. The patient was “sheepish” about not following the recommendations, but incredibly impressed by the fact that UTC could not be fooled!
In conclusion: these cases of high-level professional athletes show the sensitivity of UTC for the detection of exercise effects and for early diagnosis of developing tendon pathology. As such, it is extremely helpful for injury-prevention and –management.