title: A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players.
abstract: OBJECTIVE
  To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires.
  
  
  RESULTS
  Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness (p<0.001) and lower VISA-P scores (p=0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores (p=0.098).
  
  
  CONCLUSIONS
  Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice.
authors.affiliation: Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Australia; Department of Diagnostic Radiology, Singapore General Hospital, Singapore; Imaging at Olympic Park, AAMI Park, Australia.
authors.forename: Chin Chin
authors.initials: CC
authors.lastname: Ooi
authors.affiliation: University Hospital of North Staffordshire NHS Trust, X-ray Department, UK.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Richards
authors.affiliation: Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary, University of London, UK; Department of Musculoskeletal Surgery, University of Salerno School of Medicine and Surgery, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Oxford University Hospitals Trust, UK.
authors.forename: David
authors.initials: D
authors.lastname: Ede
authors.affiliation: Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Australia.
authors.forename: Michal E
authors.initials: ME
authors.lastname: Schneider
authors.affiliation: Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Australia; Imaging at Olympic Park, AAMI Park, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Connell
authors.affiliation: NIHR/HEE, Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, Bart's Health NHS Trust, UK.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.affiliation: Imaging at Olympic Park, AAMI Park, Australia; Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary, University of London, UK. Electronic address: p.malliaras@qmul.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Malliaras
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000000981:diagnostic imaging* / Q000503:physiopathology; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology; D054798:Volleyball / Q000502:physiology*; D055815:Young Adult
keywords: Elasticity imaging techniques; Patellar tendinopathy; Ultrasonography; Volleyball