A new paper underlines that all tendons are NOT created equal!

Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study

Coombes, B.K. et al, 2017, Scandinavian Journal of Medicine and Science in Sports, ahead of press.


To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy.


Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, 28 healthy controls) were recruited between March 2015-March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV.


Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62 m/s; P<0.001), and greater thickness at the mid-tendon (MD 0.19; 0.05 to 0.33 cm; P=0.007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40 to 2.10 m/s; P=0.005), and greater thickness proximally (MD 0.17; 0.06 to 0.29 cm; P=0.003).


Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon.

Simon Bartold
Director of Bartold Clinical