Achilles and Patella Tendons Tissue Structure in Overweight and Obese Children

Background: Overweight and obesity among children, which increased dramatically in the last decade, is related to a significant number of metabolic and physiological diseases. Among obese adults, a direct connection was found between increasing physical load activity and/or heavy weight, and the appearance of structural changes in the tendons. The aim of this study was to investigate the differences in Achilles and Patella tendon structure between overweight/obese and normal-weight children.

Methods: Twenty-two children with obesity, ten overweight children, and forty-four children of normal weight, participated in this study. BMI (Body Mass Index) % was calculated. The Achilles and Patella tendons were examined by using the Ultrasound Tissue Characterization (UTC). The Achilles tendon was examined in one point and the Patella tendon was examined at 24-week follow-up.

Results: A significantly higher percentile of echo-types II, a lower percentile of echo-types III and IV, and a lower cross-sectional area were found for the normal-weight children compared with the obese and over-weight children (p.05), both in the Achilles and the Patella tendons. Following a piecewise linear regression model according to the Achilles tendon structure, a BMI percentile of 75% was found to be the most accurate cut-off point of the children in the ‘unaffected’ (BMI%75%) and ‘affected’ tendon structure. Children (BMI% ≥ 75%) already had an Achilles tendon structure similar to that of children with overweight/obesity. The follow-up of the Patella tendon had shown differences after 12 weeks of physical training in obese and overweight children compared to normal weight children.

Conclusions: Tendon integrity as examined with UTC differs between obese and non-obese children. Children with a BMI percentile of ≥ 75% already demonstrate a different tendon structure pattern compared to lean children, and only after a 12-week program of physical training showed differences, which may indicate a greater risk of injury for obese children, and therefore should be addressed when applying an exercise program for obese and overweight children.