Background In preparation for the Olympic Games of 2024, we performed pre-season medical screenings of elite track and field athletes.

Objective As a part of these medical screenings, we performed ultrasound investigations of lower limb tendons to quantify the prevalence of tendon alterations in elite athletes in an attempt to learn more on preventing in-season symptomatic tendinopathies.

Design This is a descriptive cross-sectional study, all ultrasound investigations were performed by one highly experienced sports physician in a standardized clinical setting during 3 screening days in October of 2022.

Setting and Participants 51 male and female elite track and field athletes (age 16 – 35 years, 26 male athletes, 25 female athletes) underwent pre-season medical screening, with 306 lower limb tendons (Achilles tendons, plantar fascia and patellar tendons) being sonographically and clinically evaluated in total.

Interventions /(descriptive cross-sectional study design)

Main Outcome Measurements Tendons were qualified as sonographically normal or abnormal (tendon alterations present) and as clinically symptomatic or asymptomatic. Prevalence of sonographically detected tendon alterations and prevalence of tendinopathy were analysed descriptively by tendon and sports categories.

Results 34 Athletes didn´t have any tendon alterations on ultrasound investigation. 17 Athletes had tendon alterations on ultrasound investigation. 4 Athletes were symptomatic at the moment of screening: 2 Athletes had a unilateral patellar tendinopathy (1 decathlete, 1 discus thrower/shot putter). 1 Athlete had a bilateral patellar tendinopathy (javelin thrower). 1 Athlete had a bilateral Achilles tendinopathy (heptathlete)

Conclusion 33% (17/51) of screened athletes had sonographically detected tendon alterations, 8% (4/51) of athletes were symptomatic at the moment of musculoskeletal screening. Further clinical follow-up is planned during the track and field season to investigate which athletes become symptomatic. Additional research is required to better predict which athletes will become symptomatic during the season and ultimately try to prevent athletes from developing tendinopathies.