Ultrasonographic Knee Abnormalities and Their Association with Pain in Young Male Handball and Basketball Athletes: A...

Background/Objectives: Knee injuries and overuse-related disorders are common among athletes participating in jumping sports such as handball and basketball. Musculoskeletal ultrasonography is increasingly used for the assessment of knee pathology; however, evidence regarding the prevalence and clinical relevance of ultrasonographic abnormalities in young athletes remains limited. The aim of this study was to investigate the prevalence of ultrasonographic knee abnormalities in young male handball and basketball athletes and to examine their association with pain intensity. Methods: A cross-sectional observational study was conducted between June 2025 and June 2026 and included 69 competitive male athletes (35 handball players and 34 basketball players). All participants underwent bilateral knee ultrasonographic examination using a standardized assessment protocol and completed a questionnaire regarding demographic and training characteristics. Knee pain intensity was evaluated using the Visual Analogue Scale (VAS). Comparisons between sports were performed using χ² and t-tests, while associations between participant-level ultrasonographic findings and pain were evaluated using independent-samples t-tests (or Mann-Whitney U tests, as appropriate), with Cohen's d effect sizes and exploratory multivariable linear regression. Sensitivity analyses stratified by sport were additionally performed. Results: Patellar tendinopathy was the most prevalent ultrasonographic abnormality (21.0%), followed by medial meniscal abnormality (15.9%) and infrapatellar bursitis (13.0%). Athletes with patellar tendinopathy, medial meniscal abnormality, or infrapatellar bursitis had significantly higher VAS pain scores than athletes without the corresponding ultrasonographic abnormality. Patellar tendinopathy demonstrated the strongest association with participant-reported pain (VAS: 4.1 ± 1.3; Cohen's d = 1.24; p < 0.001). Handball athletes exhibited a significantly higher prevalence of patellar tendinopathy than basketball athletes (34.3% vs. 11.8%; OR = 3.90, 95% CI: 1.09-13.95; p = 0.027). In multivariable regression analysis adjusted for age, BMI, sport type, previous knee injury, and weekly training volume, patellar tendinopathy (β = 1.34, p < 0.001), medial meniscal abnormality (β = 0.70, p = 0.017), and infrapatellar bursitis (β = 0.54, p = 0.046) remained independently associated with higher pain scores. The regression model explained 39% of the variance in VAS pain scores (R² = 0.39). Conclusions: Ultrasonographic knee abnormalities are common among young male handball and basketball athletes and are significantly associated with pain intensity. Because ultrasonography has limited ability to characterize intra-articular pathology, particularly the menisci, the ultrasonographic abnormalities identified in this study should not be interpreted as definitive diagnoses, and MRI remains the reference imaging modality when comprehensive evaluation of intra-articular pathology is clinically indicated. Patellar tendinopathy was the most prevalent ultrasonographic abnormality and was most strongly associated with pain intensity. These findings support the use of musculoskeletal ultrasonography as a complementary imaging modality alongside clinical assessment in the evaluation of symptomatic athletes. However, prospective longitudinal studies are required to determine whether these ultrasonographic abnormalities have prognostic value for future pain, functional limitation, or time-loss injury.