TY - JOUR
T1 - Explaining Variability in the Prevalence of Achilles Tendon Abnormalities
T2 - A Systematic Review with Meta-analysis of Imaging Studies in Asymptomatic Individuals
AU - Docking, Sean Iain
AU - Hart, Harvi F.
AU - Rio, Ebonie
AU - Hannington, Madeline Claire
AU - Cook, Jill L.
AU - Culvenor, Adam G.
N1 - Funding Information:
1La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. 2Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia. 3Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. 4Collaborative Training Program in Musculoskeletal Health Research; Bone and Joint Institute, Faculty of Health Sciences, Western University, London, Canada. ORCID: Docking, https://orcid.org/0000-0001-7051-7548; Rio, https://orcid.org/0000-0002-6854-929X; Hannington, https://orcid.org/0000-0002-1305-1363; Culvenor, https://orcid.org/0000-0001-9491-0264. This review was registered with PROSPERO (CRD42018088087). This manuscript was partly supported by the National Basketball Association and GE Healthcare Orthopedics and Sports Medicine Collaboration. Aspects of this research are related to the work of the Australian Centre for Research into Injury in Sport and its Prevention, which is one of the International Olympic Committee centers of research excellence for the prevention of injuries and promotion of health in athletes. The funders had no involvement in the development, analysis, or reporting of this research. Dr Hart is supported in part by a Transdisciplinary Bone and Joint Training Award from the Collaborative Training Program in Musculoskeletal Health Research at Western University. Dr Rio is a recipient of a National Health and Medical Research Council (Australia) Early Career Fellowship (APP1142339). Madeline Claire Hannington is a recipient of a La Trobe University Postgraduate Research Scholarship. Dr Culvenor is a recipient of a National Health and Medical Research Council Early Career Fellowship (Neil Hamilton Fairley Clinical Fellowship, APP1121173). The sponsors had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Sean Docking, Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, VIC 3144 Australia. E-mail: [email protected] U Copyright ©2021 JOSPT ®, Inc
Publisher Copyright:
© 2021 Movement Science Media. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - OBJECTIVE: To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals. U DESIGN: Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH: Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020. STUDY SELECTION CRITERIA: We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions. DATA SYNTHESIS: Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity. RESULTS: We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I2>90%, P<.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; P =.015) and participation in physical activity per limb, and mean age of 40 years old or older (P =.022) per participant. CONCLUSION: There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design.
AB - OBJECTIVE: To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals. U DESIGN: Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH: Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020. STUDY SELECTION CRITERIA: We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions. DATA SYNTHESIS: Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity. RESULTS: We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I2>90%, P<.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; P =.015) and participation in physical activity per limb, and mean age of 40 years old or older (P =.022) per participant. CONCLUSION: There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design.
KW - Achilles tendon
KW - Diagnostic ultrasound imaging
KW - Incidental findings
KW - Magnetic resonance imaging
UR - https://www.scopus.com/pages/publications/85105618400
U2 - 10.2519/jospt.2021.9970
DO - 10.2519/jospt.2021.9970
M3 - Review Article
C2 - 33779214
AN - SCOPUS:85105618400
SN - 0190-6011
VL - 51
SP - 232
EP - 252
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 5
ER -