Classification of Tendon Matrix Change Using Ultrasound Imaging: A Systematic Review and Meta-analysis

Abstract

Ultrasound imaging (US) is an accurate and reliable method used to diagnose tendinopathy. This systematic review was aimed at identifying common criteria and parameters used to diagnose tendinopathy, the methodological quality of studies and the predictive value of US. Nineteen studies met the inclusion criteria, with the Achilles, quadriceps and patella tendons being investigated. Overall, there was significant heterogeneity between the criteria used to diagnose tendinopathy utilising US. The methodological quality of included studies was "good." Additionally, meta-analysis revealed that US-identified abnormalities were predictive of future symptoms, and classification of tendinopathy using three US defined parameters indicated a higher relative risk of developing clinical tendinopathy compared with the use of two US-defined parameters. Further research into the development of a standardised US criterion that incorporates both clinical and US findings is required to allow for greater consistency in the diagnosis of tendinopathy.

Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology

“…Phase 1: criteria development Following a systematic review, 31 an initial criteria was proposed that incorporated both the continuum model of tendon pathology 9 11 and common parameters used to measure tendinopathy on USI. 31 Additionally, as identified in previous studies, 18 31 34 an ordinal scale was used that included measures of tendon thickness, echogenicity and vascularisation.…”

“…31 34 This, in conjunction with the cross-sectional design of many imaging studies, 30 and lack of a clinical gold standard with which to compare images, 29 contributes to the uncertainty of the relevance of USI in the clinical diagnosis of tendinopathy. 30 When assessing current methods for diagnosing tendinopathy using USI-based criteria, a recent systematic review 31 reported that the most common parameters used to measure tendon pathology include tendon thickness, echogenicity and vascularity. Furthermore, while the stages of tendinopathy are distinguished by specific imaging features, 9 11 no studies used the continuum model of tendon pathology to stage tendinopathy.…”

“…Furthermore, while the stages of tendinopathy are distinguished by specific imaging features, 9 11 no studies used the continuum model of tendon pathology to stage tendinopathy. 31 Additionally, it was discovered that the use of a combination of the three most commonly reported parameters demonstrated a higher risk (RR 6.49) for developing symptomatic tendinopathy when compared with using two parameters (RR 3.66). 31 Therefore, it was suggested that future USI-based criteria use a combination of three parameters (tendon thickness, echogenicity and vascularity) in addition to an ordinal-based USI criteria that better aligns with the continuum model of tendon pathology ('normal', 'reactive/early dysrepair' or 'late dysrepair/degenerative').…”

“…31 Additionally, it was discovered that the use of a combination of the three most commonly reported parameters demonstrated a higher risk (RR 6.49) for developing symptomatic tendinopathy when compared with using two parameters (RR 3.66). 31 Therefore, it was suggested that future USI-based criteria use a combination of three parameters (tendon thickness, echogenicity and vascularity) in addition to an ordinal-based USI criteria that better aligns with the continuum model of tendon pathology ('normal', 'reactive/early dysrepair' or 'late dysrepair/degenerative'). 31 The continuum model of tendon pathology provides a framework for describing the pathogenesis of tendinopathy and associated clinical and imaging features.…”

“…31 Therefore, it was suggested that future USI-based criteria use a combination of three parameters (tendon thickness, echogenicity and vascularity) in addition to an ordinal-based USI criteria that better aligns with the continuum model of tendon pathology ('normal', 'reactive/early dysrepair' or 'late dysrepair/degenerative'). 31 The continuum model of tendon pathology provides a framework for describing the pathogenesis of tendinopathy and associated clinical and imaging features. The staging of tendon pathology may be beneficial for clinicians to target treatment according to the tendon structure.…”