title: Ultrasound does not provide reliable results for the measurement of the patellar tendon cross sectional area.
abstract: OBJECTIVE
  This study examined the reliability of patellar tendon cross sectional area (CSA) measurement using brightness mode ultrasonography.
  
  
  METHODS
  The patellar tendon CSA of fourteen participants was examined on two different days and at three different positions (proximal, median and distal). Five trials per day were conducted in each position, replacing the ultrasound probe on every trial. The images were examined by three different and equally experienced observers. We compared the mean of the five trials in each position to examine the day, observer and position effect. Further, Bland and Altman plots, root mean square (RMS) differences and intraclass correlation coefficients (ICC) were calculated.
  
  
  RESULTS
  There was a significant (p < 0.05) day, observer and position effect on the CSA, while the average ICC was 0.592. The Bland and Altman plots showed that differences between conditions or groups, should be in average lower than 37% or higher than 55% of the patellar tendon CSA to be important for clinical or intervention studies.
  
  
  CONCLUSIONS
  Our findings show low reliability of the method, which resulted from the low clarity and unclear visibility of tissue boundaries in the ultrasound images. Therefore, the measurement of the CSA of the patellar tendon using ultrasound does not provide accurate and reliable results.
authors.affiliation: Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany.
authors.forename: Antonis
authors.initials: A
authors.lastname: Ekizos
authors.forename: Fyllis
authors.initials: F
authors.lastname: Papatzika
authors.forename: Georgios
authors.initials: G
authors.lastname: Charcharis
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bohm
authors.forename: Falk
authors.initials: F
authors.lastname: Mersmann
authors.forename: Adamantios
authors.initials: A
authors.lastname: Arampatzis
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019412:Anatomy, Cross-Sectional; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D011187:Posture; D015203:Reproducibility of Results; D014463:Ultrasonography; D014741:Video Recording
keywords: Accuracy; Repeatability; Reproducibility; Tendon adaptation; Tendon size