- Email: [email protected]
The intertester reliability of ultrasound for the assessment of patellar tendinopathy
Physi o t h er ap y co r rect s an abnorm al gait pat t ern in p a t e l l o f e m o r a l pain K. Crossley*~, S.Cowan~, K. Bennell1 & J. McConnell2 ~Centre For Sports Medicine Research & Education 2McConnell & Clements Physiotherapy, Sydney, Australia
During gait, individuals with patellofemoral pain (PFP) may reduce their stance-phase knee flexion to lessen their patellofemoral joint reaction force and thus minimise symptom aggravation. Restoration of normal gait kinematics is desirable. This study aimed to investigate stance-phase knee flexion in participants with and without PFP and to determine whether a physiotherapy intervention affected stance-phase knee flexion. A cross-sectional design was used to assess knee flexion during the stance-phase of stair ambulation in individuals with and without PFP. Participants with PFP had significantly less knee flexion at heel-strike and peak stance-phase knee flexion than control participants. A randomised, double-blind, placebo control trial was used to investigate the effects of a physiotherapy intervention on stance-phase knee flexion during stair ambulation. Measurements were taken from 22 participants with PFP who were enrolled in a larger randomised controlled trial. Baseline pain, disability and stance-phase knee flexion variables were similar between the two groups. After the six-week intervention period, those in the physiotherapy group had a significantly greater increase in knee flexion at heel strike and in the peak stance-phase knee flexion during stair descent compared with participants in the placebo treatment group.
The i n t e r t e s t e r reliability of ultrasound for the a s s e s s m e n t of patellar tendinopathy J. Black*~, J.Cook 2, Z. Kiss3& M. Smith 3 ~School Of Physiotherapy, La Trobe University, Bundoora, Melbourne, Australia 2Musculoskeletal Research Centre, School Of Physiotherapy, La Trobe University, Bundoora, Melbourne, Australia 3East Melbourne Radiology, East Melbourne, Australia
The treatment of patellar tendinopathy has been poorly investigated (Almekinders & Temple, 1998) and collaboration with research groups is now required. Such collaboration recruits larger subject numbers but also requires diagnostic reliability. Although there many papers have reported ultrasound to be operator dependent, the intertester reliability has never been formally investigated in human tendons. Two radiologists assessed 24 patellar tendons for the presence of a hypoechoic area. The detected hypoechoic areas were then measured for sagittal plane maximal height and axial plane maximal width and height. All tendons were measured for sagittal plane height at the proximal and distal attachments. There was perfect agreement between the radiologists for the detection of hypoechoic areas (Kappa = 1). The radiologists demonstrated good association for all tendon and hypoechoic area measurements (Pearson's r >0.86 for every measurement site). Statistically significant differences were only found between the radiologists for measurements of sagittal plane tendon height at the tibial insertion. (p<0.05). The results of this pioneer study therefore suggest that equivalent radiologists can reliably undertake image acquisition. This questions the widely accepted, but not evidenced-based, theory regarding the operator dependency of ultrasound. This study has therefore provided researchers with the necessary foundation to further research in tendon rehabilitation Reference: Almekinders, L. C., & Temple, J. D. (1998). Etiology, diagnosis, and treatment of tendonitis- An analysis of the literature. Medicine & Science in Sports & Exercise, 30(8), 1183-1190. 119
During gait, individuals with patellofemoral pain (PFP) may reduce their stance-phase knee flexion to lessen their patellofemoral joint reaction force and thus minimise symptom aggravation. Restoration of normal gait kinematics is desirable. This study aimed to investigate stance-phase knee flexion in participants with and without PFP and to determine whether a physiotherapy intervention affected stance-phase knee flexion. A cross-sectional design was used to assess knee flexion during the stance-phase of stair ambulation in individuals with and without PFP. Participants with PFP had significantly less knee flexion at heel-strike and peak stance-phase knee flexion than control participants. A randomised, double-blind, placebo control trial was used to investigate the effects of a physiotherapy intervention on stance-phase knee flexion during stair ambulation. Measurements were taken from 22 participants with PFP who were enrolled in a larger randomised controlled trial. Baseline pain, disability and stance-phase knee flexion variables were similar between the two groups. After the six-week intervention period, those in the physiotherapy group had a significantly greater increase in knee flexion at heel strike and in the peak stance-phase knee flexion during stair descent compared with participants in the placebo treatment group.
The i n t e r t e s t e r reliability of ultrasound for the a s s e s s m e n t of patellar tendinopathy J. Black*~, J.Cook 2, Z. Kiss3& M. Smith 3 ~School Of Physiotherapy, La Trobe University, Bundoora, Melbourne, Australia 2Musculoskeletal Research Centre, School Of Physiotherapy, La Trobe University, Bundoora, Melbourne, Australia 3East Melbourne Radiology, East Melbourne, Australia
The treatment of patellar tendinopathy has been poorly investigated (Almekinders & Temple, 1998) and collaboration with research groups is now required. Such collaboration recruits larger subject numbers but also requires diagnostic reliability. Although there many papers have reported ultrasound to be operator dependent, the intertester reliability has never been formally investigated in human tendons. Two radiologists assessed 24 patellar tendons for the presence of a hypoechoic area. The detected hypoechoic areas were then measured for sagittal plane maximal height and axial plane maximal width and height. All tendons were measured for sagittal plane height at the proximal and distal attachments. There was perfect agreement between the radiologists for the detection of hypoechoic areas (Kappa = 1). The radiologists demonstrated good association for all tendon and hypoechoic area measurements (Pearson's r >0.86 for every measurement site). Statistically significant differences were only found between the radiologists for measurements of sagittal plane tendon height at the tibial insertion. (p<0.05). The results of this pioneer study therefore suggest that equivalent radiologists can reliably undertake image acquisition. This questions the widely accepted, but not evidenced-based, theory regarding the operator dependency of ultrasound. This study has therefore provided researchers with the necessary foundation to further research in tendon rehabilitation Reference: Almekinders, L. C., & Temple, J. D. (1998). Etiology, diagnosis, and treatment of tendonitis- An analysis of the literature. Medicine & Science in Sports & Exercise, 30(8), 1183-1190. 119