Intra- und interobserver Variabilität sonografischer Untersuchungen an Patella- und Achillessehnen

Zusammenfassung

Hintergrund: Obwohl die Sonografie in der Diagnostik von Läsionen an Achilles- und Patellasehnen etabliert ist, liegen bislang nur wenige Daten zu Gütekriterien dieser Messungen vor. Ziel der Studie war es daher, die Reliabilität in der Bestimmung des Sehnendurchmessers bzw. in der Darstellung struktureller Veränderungen zu untersuchen.

Material und Methoden: Bei 14 gesunden Freizeitsportlern wurden je beide Achilles- (AS) und Patellasehnen (PS) im Test-Retest-Design durch zwei Untersucher sonografiert. Neben antero-posteriorem (a.p.-) und mediolateralem (m.l.-) Durchmesser wurde das Auftreten von Hypoechogenitäten und Vaskularisationen erfasst. Es erfolgte die deskriptive Analyse mit Kalkulation von Test-Retest-Variabilität (TRV), Intraclass-Correlation-Coefficient (ICC) und Bland und Altman’s Plots mit Bias und 95 % Limits of Agreement (LOA).

Ergebnisse: Die intra- und interobserver Differenzen von AS- und PS-a.p.-Durchmesser variierten von 0,2 – 1,2 mm, die der AS- und PS-m.l-Durchmesser von 0,7 – 5,1 mm. Bei 24 % der geschallten Sehnen waren Hypoechogenitäten sichtbar, in 15 % der untersuchten Sehnen wurden Vaskularisationen beobachtet. Die Bestimmung des intra-observer AS-a.p.-Durchmessers zeigte lediglich geringe Abweichungen (TRV 4,5 – 7,4 %; ICC 0,60 – 0,84; Bias −0,05 – 0,07 mm; LOA −0,6 – 0,5 bis −1,1 – 1,0 mm), während AS- und PS-m.l.-Durchmesser zwischen den Untersuchern stärker variierten (TRV 13,7 – 19,7 %; ICC 0,11 – 0,20; Bias −1,4 – 4,3 mm; LOA −5,5 – 2,7 bis −10,5 – 1,9 mm).

Schlussfolgerung: Der AS- und PS-a.p.-Durchmesser sind zuverlässig zu bestimmende Parameter. Demgegenüber ist die reliable Erfassung der Sehnenbreite von Achilles- und Patellasehnen erschwert. Hypoechogenitäten und Vaskularisationen sind bereits in klinisch unauffälligen Sehnen darstellbar.

Abstract

Background: Clinical examinations of tendon disorders routinely include ultrasound examinations, despite the fact that availability of data concerning validity criteria of these measurements are limited. The present study therefore aims to evaluate the reliability of measurements of Achilles- and Patella tendon diameter and in the detection of structural adaptations.

Materials and Methods: In 14 healthy, recreationally active subjects both asymptomatic Achilles (AT) and patella tendons (PT) were measured twice by two examiners in a test-retest design. Besides the detection of anteroposterior (a.p.-) and mediolateral (m.l.-) diameters, areas of hypoechogenicity and neovascularisation were registered. Data were analysed descriptively with calculation of test-retest variability (TRV), intraclass-correlation coefficient (ICC) and Bland and Altman’s plots with bias and 95 % limits of agreement (LOA).

Results: Intra- and interrater differences of AT- and PT-a.p.-diameter varied from 0.2 – 1.2 mm, those of AT- and PT-m.l-diameter from 0.7 – 5.1 mm. Areas of hypoechogenicity were visible in 24 % of the tendons, while 15 % showed neovascularisations. Intrarater AT-a.p. -diameters showed sparse deviations (TRV 4.5 – 7.4 %; ICC 0.60 – 0.84; bias −0.05 – 0.07 mm; LOA −0.6 – 0.5 to −1.1 – 1.0 mm), while interrater AT- and PT-m.l.-diameters were highly variable (TRV 13.7 – 19.7 %; ICC 0.11 – 0.20; bias −1.4 – 4.3 mm; LOA −5.5 – 2.7 to −10.5 – 1.9 mm).

Conclusion: Our results suggest that the measurement of AT- and PT-a.p. -diameters is a reliable parameter. In contrast, reproducibility of AT- and PT-m.l.-diameters is questionable. The study corroborates the presence of hypoechogenicity and neovascularisation in asymptomatic tendons.

Schlüsselwörter

Ultraschall - Achillessehne - Patellasehne - Intra- und interobserver Variabilität - Sehnendurchmesser

Key words

ultrasound - Achilles tendon - Patella tendon - intra- and inter-rater variability - tendon diameter

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