Clinical improvements are not explained by changes in tendon structure on ultrasound tissue characterization after an exercise program for patellar tendinopathy

Mathijs Van Ark, Ebonie Rio, Jill Cook, Inge Van Den Akker-Scheek, James E. Gaida, Johannes Zwerver, Sean Docking

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21 Citations (Scopus)


Objectives The aim of this study was to investigate the effects of a 4-wk in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by ultrasound tissue characterization (UTC). Design This was a randomized clinical trial. Volleyball and basketball players (16-31 yrs, n = 29) with clinically diagnosed patellar tendinopathy were randomized to a 4-wk isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-wk UTC scan was used to evaluate change in tendon structure. Results No significant change in tendon structure or dimensions on UTC was detected after the exercise program despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area of aligned fibrillar structure (echo types I + II) (Z = -0.414, P = 0.679) as well as disorganized structure (echo types III + IV) (Z = -0.370, P = 0.711) did not change over the 4-wk exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Conclusion Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-wk isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement in symptoms. It seems that structural improvements are not required for a positive clinical outcome.

Original languageEnglish
Pages (from-to)708-714
Number of pages7
JournalAmerican Journal of Physical Medicine & Rehabilitation
Issue number10
Publication statusPublished - Oct 2018


  • Patellar Ligament
  • Tendinopathy
  • Tendons
  • Ultrasonography

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