title: Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale.
abstract: OBJECTIVE
  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.
authors.affiliation: Stockholm Sports Trauma Research Centre/Karolinska Institutet, Capio Artro Clinic AB, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden. kerstin.sunding@capio.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Sunding
authors.affiliation: Department of Clinical Sciences, Professional Development, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Fahlström
authors.affiliation: Stockholm Sports Trauma Research Centre/Karolinska Institutet, Capio Artro Clinic AB, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Werner
authors.affiliation: Stockholm Sports Trauma Research Centre/Karolinska Institutet, Capio Artro Clinic AB, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Forssblad
authors.affiliation: Stockholm Sports Trauma Research Centre/Karolinska Institutet, Capio Artro Clinic AB, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Willberg
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D017847:Patellar Ligament / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D018615:Ultrasonography, Doppler, Color
keywords: Echogenicity; Inter-observer reliability; Neovascularisation; Tendon structure; Öhberg score