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Original article
Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler
  1. James Watson1,2,
  2. Robert M Barker-Davies1,3,
  3. Alexander N Bennett1,4,
  4. Daniel T P Fong3,
  5. Patrick C Wheeler3,
  6. Mark Lewis3,
  7. Craig Ranson5
  1. 1Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, London, UK
  2. 2Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
  3. 3National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, London, UK
  4. 4Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
  5. 5Athlete Health Department, English Institute of Sport, Manchester, UK
  1. Correspondence to Dr Robert M Barker-Davies; robbarker-davies{at}doctors.net.uk

Abstract

Objective Several lower limb tendinopathy treatment modalities involve identification of pathological paratendinous or intratendinous neovascularisation to target proposed co-location of painful neoneuralisation. The ability to reliably locate and assess the degree of neovascularity is therefore clinically important. The Modified Ohberg Score (MOS) is frequently used to determine degree of neovascularity, but reliability has yet to be established among Sport and Exercise Medicine (SEM) consultants. This study aims to determine inter-rater and intra-rater reliability of an SEM consultant cohort when assessing neovascularity using the 5-point MOS.

Method Eleven participants (7 male and 4 female) provided 16 symptomatic Achilles and patella tendons. These were sequentially examined using power Doppler (PD) enabled ultrasound (US) imaging by 6 SEM consultants who rated neovascular changes seen using the MOS. Representative digital scan images were saved for rescoring 3 weeks later. Inter-rater and intra-rater reliability of the MOS was examined using intraclass correlation coefficient (ICC) and Kappa Agreement scores.

Results Neovascular changes were reported in 65.6% of 96 scans undertaken. ICC for inter-rater reliability was 0.86 and Fleiss Kappa 0.52. ICC for intra-rater reliability was 0.95 and Weighted Kappa 0.91.

Conclusions Neovascular changes were present in two-thirds of symptomatic tendons. Excellent SEM consultant inter-rater and intra-rater reliability was demonstrated. These findings support the use of PD-enabled US to assess neovascularity by appropriately experienced SEM consultants. Furthermore, future interventional research using a similarly experienced SEM consultant cohort can be undertaken with assurance that assessment of neovascularity will be reliable.

  • tendinopathy
  • achilles
  • ultrasound

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjsem-2017-000298

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    Footnotes

    • JW and RMB-D are the joint-first authors.

    • Contributors JW and RMB-D contributed equally in study design, ethical approval, study implementation, clinical protocols, drafting and editing of the manuscript. ANB is responsible for study design, clinical protocols, ethical approval, clinical and scientific supervision of manuscript drafting, editing and review. DTPF, ML and CR are responsible for study design, scientific protocols, clinical and scientific supervision, manuscript editing and review. PCW is responsible for study design, clinical protocols, scientific protocols, clinical and scientific supervision, manuscript editing and review. All authors read and approved the final manuscript.

    • Funding This study has attracted funding through Loughborough University from the Higher Education Funding Council for England and a PhD Studentship.

    • Competing interests None declared.

    • Ethics approval Ethical approval was obtained via both the Ministry of Defence Research and Ethics Committee (684/MODREC/15) and the Cardiff Metropolitan University School of Sport Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.