We aimed to examine the relationship between clinical diagnosis of tendinopathy, tendon structure, and muscle strength in 207 rhythmic, acrobatic and artistic elite female gymnasts over a period of 12 months (age 11.9 ± 1.8 years at baseline). Participants were assessed for patellar-tendon and Achilles-tendon structure, anthropometric parameters, and muscle strength, and were physically examined for clinical tendinopathy of the patella and the Achilles. At baseline, 26.6% and 31.4% of the gymnasts had clinical tendinopathy in the patellar or Achilles tendon, respectively. At follow-up, 37.2% and 38.6% remained healthy; 9.7% and 15.5% recovered; 36.2% and 30.0% developed clinical tendinopathy; and 16.9% and 15.9% remained with clinical tendinopathy, respectively. The healthy and recovered groups exhibited decreased prevalence of disorganised patellar tendon and Achilles tendon fibres from baseline to follow-up, while those who sustained or had developed tendinopathy showed increased prevalence (p < 0.05). A high prevalence of clinical tendinopathy was observed among adolescent female gymnasts, with a limited chance of recovery. At baseline, gymnasts without tendinopathy exhibited higher muscle strength and lower prevalence of disorganised tendon fibres than gymnasts with tendinopathy. At follow-up, recovered gymnasts exhibited higher muscle strength and lower prevalence of disorganised tendon fibres than those who had sustained or developed tendinopathy.
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