Inter-rater Reliability of Sports Medicine Physicians to Assess Healthy Individuals' Patellar Tendon with Conventional Ultrasound and Shear-wave Elastography

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To evaluate the reproducibility of shear-wave elastography, thickness, power doppler, and hypoechoic region assessments taken from the different parts of the patellar tendon among sports medicine clinicians. Twenty-one healthy, physically active individuals with dominant legs were included in the study. Shear-wave elastography, thickness, power doppler, and hypoechoic area assessment were evaluated from the proximal, middle, and distal part of the tendon both at 30-degree knee flexion and full extension. To evaluate the reproducibility within and among clinicians, the same measurements were performed at 4-7 days intervals. Evaluations of intra- and inter-rater reliability for examiners I and II were conducted via two-way random effects and absolute agreement type intraclass correlation coefficient (ICC). Gwet’s AC1 (GC) agreement coefficient was used to evaluate categorical data agreement. The intra-rater reliability of both sports physicians on shear-wave elastography was in good to excellent reproducibility in all three parts at the 0–30-degree measurements (intra-observer ICC: 0.60-0.88, inter-observer ICC: 0.67-0.87). Similar results were obtained for the thickness (intra-observer ICC: 0.83-0.94, inter-observer ICC: 0.65-0.83). As a result of the power doppler taken at two different angles were excellently (intra-observer GC: 0.86-1.00, inter-observer GC: 0.86-1.00) consistent both within and among the clinicians but not for the hypoechoic region evaluation (intra-observer GC: 0.58-1.00, inter-observer GC: 0.40-1.00). This study shows that the reproducibility of local measurements made in different parts of the patellar tendon at two different angles within and among sports medicine physicians is at a good to an excellent level.