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Editor,—I write with reference to the letter of Khan and Kannus.1 I concur that Gibbon and colleagues are not in a position to draw a conclusion on the diagnostic ultrasound screening of athletes suggesting that sonographic abnormality will lead to a complete rupture. However, I also do not fully agree with the authors of the letter that tissue based pathologies found by Kannus and Jozsa2 may be more subtle than can be detected by sonography.
To explain, I feel that part of the problem, resulting in this divergence of opinion, lies both with the diversity of the diagnostic ultrasound equipment used and the skill of the operator. There is little standardisation of either of the techniques used by operators or, in particular, equipment specification. To this end, articles that report studies correlating diagnostic ultrasound findings with other clinical markers have to be carefully interpreted.
Colleagues and I have been regularly performing musculoskeletal ultrasound examinations, particularly on Achilles and supraspinatus tendons. We regularly visualise degenerative changes in asymptomatic tendons that do not go on to rupture or produce significant problems.
We have conducted a three year prospective controlled study that linked diagnostic ultrasonography data to clinical presentation/symptoms. The results showed a strong correlation between the ultrasound findings and the clinical markers used, such as pain, stiffness, and functional ability.
To conclude, ultrasound is a useful and I believe an effective tool to aid in the diagnostic process to evaluate tendon pathology. However, it is only part of the process and, in isolation, can be as misleading as it is helpful.