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Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In tendon research, using ultrasound (US), studies often refer to tendon thickness, structural abnormalities and neovascularisation. The reliability concerning these measurements and evaluations is seldom reported. The aim of this study was to assess the intra- and inter-observer reliability for quantitative measures (thickness) and qualitative evaluations (structure and neovascularisation) of symptomatic and asymptomatic Achilles and patellar tendons with US and colour Doppler using a modified Öhberg score.

Methods

Twenty-eight consecutive patients with symptomatic and asymptomatic Achilles (n = 27) and patellar tendons (n = 26) were included. Tendon anteroposterior thickness was measured. Tendon structure and neovascularisation were evaluated using a modified Öhberg score. US-images were evaluated twice by four independent observers.

Results

Mean thickness for Achilles and patellar tendons was 8.4 mm (±2.0) and 5.5 mm (±1.7), respectively. The reliability for measures of distance was high all over (ICC = 0.963–0.999). A moderate-strong correlation was found between observers concerning evaluation of neovascularisation (r = 0.767–0.992) and poor-moderate correlation concerning evaluation of structural changes (r = 0.379–0.837). Intra-observer reliability was moderate strong for evaluations of both tendon structure (k = 0.537–0.873) and neovascularisation (k = 0.639–0.864).

Conclusions

With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.

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Acknowledgments

This study was funded by the Swedish National Centre for Research in Sports, and all clinical resources were provided by Capio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden. Our great appreciation to Per Larsson, biomedical technician, and Urban Niklasson, MD PhD, for their valuable contribution in collecting data and also to Dr Lars Öhberg, MD PhD, for invaluable advice and guidance in ultrasound imaging and evaluations of tendon pathology.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Stockholm Sports Trauma Research Centre/Karolinska Institutet, Capio Artro Clinic AB, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden

    Kerstin Sunding, Suzanne Werner, Magnus Forssblad & Lotta Willberg

  2. Department of Clinical Sciences, Professional Development, Umeå University, 901 87, Umeå, Sweden

    Martin Fahlström

Authors
  1. Kerstin Sunding
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  2. Martin Fahlström
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  3. Suzanne Werner
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  4. Magnus Forssblad
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  5. Lotta Willberg
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Corresponding author

Correspondence to Kerstin Sunding.

Electronic supplementary material

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167_2014_3270_MOESM1_ESM.tif

Achilles tendons in longitudinal and transversal views. US-images showing examples of how the structure was evaluated with the use of Öhberg score (0-3) according to consensus between observers. Scores are shown in the middle, between images. (TIFF 582 kb)

167_2014_3270_MOESM2_ESM.tif

Patellar tendons in longitudinal and transversal views. US-images showing examples of how the structure was evaluated with the use of Öhberg score (0-3) according to consensus between observers. Scores are shown in the middle, between images. (TIFF 593 kb)

167_2014_3270_MOESM3_ESM.tif

US-images showing examples of how neovascularisation was evaluated with the use of Öhberg score (0-3) according to consensus between observers. Scores are shown in the middle, between images. To the left Achilles tendons and to the right Patellar tendons. (TIFF 792 kb)

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Sunding, K., Fahlström, M., Werner, S. et al. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surg Sports Traumatol Arthrosc 24, 1988–1996 (2016). https://doi.org/10.1007/s00167-014-3270-4

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  • DOI: https://doi.org/10.1007/s00167-014-3270-4

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