Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.
Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands.
Scand J Med Sci Sports. 2019 Aug;29(8):1205-1211. doi: 10.1111/sms.13439. Epub 2019 May 22.
Ultrasound tissue characterization (UTC) is used in research and clinical practice to quantify tendon structure of the patellar tendon. This is the first study to investigate the inter- and intra-rater reliability for UTC of the patellar tendon on a large scale.
Fifty participants (25 patellar tendinopathy, 25 asymptomatic) were recruited. The affected patellar tendons in symptomatic and right tendons in asymptomatic participants were scanned with UTC twice by one researcher and once by another. The same was done for contour marking (needed to analyze a UTC scan) of the tendon. Intraclass correlation coefficient (ICC (2,1)) for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized structure (echo-types III + IV) were calculated. This was done for UTC scans as well as solely marking contours.
Inter-rater reliability showed fair to good ICC values for echo-types I (0.65) and II (0.46) and excellent ICC values for echo-type III (0.81), echo-type IV (0.83), aligned fibrillar structure (0.82), and disorganized structure (0.82). Intra-rater reliability showed excellent ICC values for echo-types I (0.76), III (0.88), IV (0.85), aligned fibrillar structure (0.88), and disorganized fibrillar structure (0.88) and a fair to good value for echo-type II (0.61). Contour marking showed excellent ICC values for all echo-types.
This study showed that UTC scans for patellar tendons have overall good intra-rater and inter-rater reliability. To optimize reliability of UTC scans of the patellar tendon, using the same rater and using aligned fibrillar structure (echo-types I + II combined) and disorganized structure (echo-types III + IV combined) as outcome measures can be considered.
超声组织特征（UTC）用于研究和临床实践中，以定量评估髌腱的结构。这是第一项研究，旨在大规模调查髌腱 UTC 的组内和组间可靠性。
招募了 50 名参与者（25 名髌腱病，25 名无症状）。在症状性参与者的患侧髌腱和无症状性参与者的右侧髌腱上，由一位研究人员进行两次 UTC 扫描，另一位研究人员进行一次 UTC 扫描。同样对腱进行轮廓标记（用于分析 UTC 扫描）。计算出 I、II、III、IV 型回声、排列纤维结构（I+II 型回声）和紊乱结构（III+IV 型回声）的组内相关系数（ICC（2,1））。这是对 UTC 扫描和仅标记轮廓的情况进行的。
组间可靠性显示 I 型（0.65）和 II 型（0.46）回声的 ICC 值为中等到良好，III 型（0.81）、IV 型（0.83）回声、排列纤维结构（0.82）和紊乱纤维结构（0.82）的 ICC 值为优秀。组内可靠性显示 I 型（0.76）、III 型（0.88）、IV 型（0.85）回声、排列纤维结构（0.88）和紊乱纤维结构（0.88）的 ICC 值为优秀，II 型（0.61）的 ICC 值为中等到良好。轮廓标记显示所有回声类型的 ICC 值均为优秀。
本研究表明，髌腱的 UTC 扫描总体具有良好的组内和组间可靠性。为了优化髌腱 UTC 扫描的可靠性，可以考虑使用相同的评分者，并将排列纤维结构（I+II 型回声组合）和紊乱纤维结构（III+IV 型回声组合）作为结局指标。
