Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

J L Cook¹, K M Khan², Z S Kiss³, C R Purdam⁴, L Griffiths⁵ and For The Victorian Institute Of Sport Tendon Study Group

¹ School of Physiotherapy, Latrobe University, Bundoora, Australia 3083
² Department of Family Medicine (Sports Medicine) and School of Human Kinetics, University of British Columbia, Vancouver, Canada
³ East Melbourne Radiology, East Melbourne, Australia
⁴ Australian Institute of Sport, Canberra, Australia
⁵ Griffith University, Southport, Australia

Correspondence to:
Correspondence to: J L Cook cook.evans{at}bigpond.com

Background—Palpation is an important clinical test for jumper's knee.

Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality.

Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively.

Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01).

Conclusions—In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Key Words: patellar tendon; ultrasound; palpation; reliability; athletes

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Warden, S. J., Metcalf, B. R., Kiss, Z. S., Cook, J. L., Purdam, C. R., Bennell, K. L., Crossley, K. M. (2008). Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 47: 467-471 [Abstract] [Full Text]  
• Wang, L., Qin, L., Lu, H.-b., Cheung, W.-h., Yang, H., Wong, W.-n., Chan, K.-m., Leung, K.-s. (2008). Extracorporeal Shock Wave Therapy in Treatment of Delayed Bone-Tendon Healing. Am J Sports Med 36: 340-347 [Abstract] [Full Text]  
• Bisseling, R. W, Hof, A. L, Bredeweg, S. W, Zwerver, J., Mulder, T. (2007). Relationship between landing strategy and patellar tendinopathy in volleyball. Br. J. Sports. Med. 41: e8-e8 [Abstract] [Full Text]  
• Gisslen, K., Gyulai, C., Nordstrom, P., Alfredson, H. (2007). Normal clinical and ultrasound findings indicate a low risk to sustain jumper's knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players. Br. J. Sports. Med. 41: 253-258 [Abstract] [Full Text]  
• Warden, S. J., Kiss, Z. S., Malara, F. A., Ooi, A. B. T., Cook, J. L., Crossley, K. M. (2007). Comparative Accuracy of Magnetic Resonance Imaging and Ultrasonography in Confirming Clinically Diagnosed Patellar Tendinopathy. Am J Sports Med 35: 427-436 [Abstract] [Full Text]  
• Hoksrud, A., Ohberg, L., Alfredson, H., Bahr, R. (2006). Ultrasound-Guided Sclerosis of Neovessels in Painful Chronic Patellar Tendinopathy: A Randomized Controlled Trial. Am J Sports Med 34: 1738-1746 [Abstract] [Full Text]  
• Malliaras, P, Cook, J, Ptasznik, R, Thomas, S (2006). Prospective study of change in patellar tendon abnormality on imaging and pain over a volleyball season.. Br. J. Sports. Med. 40: 272-274 [Abstract] [Full Text]  
• Rabin, A. (2006). Is there evidence to support the use of eccentric strengthening exercises to decrease pain and increase function in patients with patellar tendinopathy?. ptjournal 86: 450-456 [Full Text]  
• Gisslen, K, Alfredson, H, Peers, K (2005). Neovascularisation and pain in jumper's knee: a prospective clinical and sonographic study in elite junior volleyball players * Commentary. Br. J. Sports. Med. 39: 423-428 [Abstract] [Full Text]  
• Gisslen, K, Gyulai, C, Soderman, K, Alfredson, H (2005). High prevalence of jumper's knee and sonographic changes in Swedish elite junior volleyball players compared to matched controls. Br. J. Sports. Med. 39: 298-301 [Abstract] [Full Text]  
• Hamilton, B, Purdam, C (2004). Patellar tendinosis as an adaptive process: a new hypothesis. Br. J. Sports. Med. 38: 758-761 [Abstract] [Full Text]  
• Cook, J L, Khan, K M (2001). What is the most appropriate treatment for patellar tendinopathy?. Br. J. Sports. Med. 35: 291-294 [Full Text]