Patella Tendon and Achilles Tendon Structures among Children and Adolescents of Different Weight

Overweight and obesity among children have increased dramatically in the last decade. There is proof that obesity during childhood is related to a significant number of metabolic and physiological diseases, and comorbidities such as diabetes. In addition, gait patterns and irregular foot structures which influence walking patterns and the ability to walk short and long distances, have been found different in obese children compared to normal weight children. However, few researches have discussed the influence of childhood obesity, on the structure and function of the skeletal body and its soft tissues.

The Patella tendon and the Achilles tendon located in the distal limbs are naturally weight bearing tendons. In cases of obese people, where there is more weight to carry, these tendons are exposed to larger loads therefore, more vulnerable to structural changes. Ranging from the easiest changes like disorganized fibrillar matrix, up to difficult changes like Achilles and Patella tendinopathy.

Physical activity can be a good and effective solution to reduce weight, however, one must be careful with the frequency and the load that the tendons are expose to.

In general, tendons react positively to optimal load, resulting in a stronger and more load-tolerant tendon by improving the tendon`s structure and remodeling it. On the other hand, when the load is excessive, the tendons may react in a negative way where the tendons transition into a reactive tendinopathy or degeneration stage.

For many years, the use of the conventional ultrasound (US) was introduced as a reliable method for the quantification of the tendon structure. However, the problem with this device was that it was often subjectively graded, with limited ability to quantify tendon structure and integrity. Recently, a new imaging technique that attempts to remove the reliance on subjective interpretation, and to use the features of US to quantify parameters in the tendon, called ultrasound tissue characterization (UTC), was invented. The UTC creates a three-dimensional image, rendered from 600 transverse US images that are captured every 0.2 mm over the length of the tendon. This technique enables us to define the different types of fibers that compose the tendon’s structure.

In adults, the correlation between obesity and structural changes in the Achilles and the Patella tendons is significant. Is this the same in children? The aim of this review is to better understand the correlation between obesity, physical activity, and tendon structure among obese children. It is hoped that the conclusions of the present review and additional future studies will open new venues for better understanding of the impact of continuous weight/loads on children`s tendons; and, for suggesting the optimal exercises/loads for obese children who enter a weight-reducing exercise program and are at high risk for musculoskeletal injuries.