Clinical Science: Original PaperUltrasound and Power Doppler findings in jumper's knee — preliminary observations
Introduction
A disagreement in the literature exists on whether or not jumper's knee (JK) is an inflammatory rather than a degenerative condition and most authors believe in the degenerative theory due to the lack of histological evidence of inflammation (Almekinders and Temple, 1998, Davies et al., 1991, Cook et al., 1997, Kälebo et al., 1991, Kahn et al., 1996, Nichols, 1992). However, in treatment of JK, NSAID's and steroid injections are often used with marked clinical effect pointing towards an inflammatory component in this condition (Almekinders and Temple, 1998, Nichols, 1992). Ultrasonography is a valuable tool in the diagnosis of JK (Davies et al., 1991, Nichols, 1992, Laine et al., 1987, Weinberg et al., 1998). JK is a painful condition in the patellar tendon and is seen among athletes who submit their knee extensor mechanism to intense and repeated stress and especially basketball players are at high risk (Cook et al., 1997).
The gray-scale ultrasonographic changes consisting of hypoechoic areas in the patellar tendon in both longitudinal and transverse scans (Fig. 1, Fig. 2) are a constant observation at all the stages of the disease (Davies et al., 1991, Nichols, 1992, Laine et al., 1987, Weinberg et al., 1998, Cook et al., 1997). In some selected materials of late stage disease a very close relationship has been described between clinical symptoms and signs and ultrasonographic changes (Davies et al., 1991, Cook et al., 1997, Kälebo et al., 1991). These findings have been in accordance with subsequent histological examination after operation. In contrast, in earlier stages of the disease, the results may be more dissociated (Lian et al., 1996), and no histological evidence has so far been obtained from these cases as they are not operated and no biopsies are taken from these tendons.
Recently, it has been possible to apply Power Doppler in the examination of musculoskeletal tissues and by this method depict hyperaemia in musculoskeletal inflammatory disease (Newman et al., 1996, Breidahl et al., 1996).
We had the opportunity to test top-players from the Danish basketball elite before and after a match. The aim of the present study was to examine, by ultrasonography, a group of high risk athletes, high-elite basketball players, for signs of inflammation in JK using Power Doppler. We examined the athletes before and after a clinical situation characterized by high intensity stress to evaluate a possible effect on tendon changes. We also compared gray-scale US and color/Power Doppler findings in JK.
The examination was carried out by both gray scale sonography and by Power Doppler.
The correlations between symptoms, clinical findings and ultrasonographic findings were also investigated in this non-selected, prospective material.
Section snippets
Material and methods
Two male teams of high-elite basketball players were asked to participate in an ultrasound (US) examination before and after an important match in the Danish premier league. Due to emotional stress only seven volunteered to an examination before the match and in one of these players the ultrasound examination was interrupted after one knee examination due to a meeting with the coach. All 18 players participated in the US examination and the questionnaire after the match but only 17 agreed to
Examination after the match
After the match 18 players were examined. According to the questionnaire only four had knee symptoms at the time of examination. They, and seven other players, had earlier had knee symptoms (Table 1).
Three of the four players with knee symptoms had both hypoechoic areas and Power Doppler flow (Fig. 3). The last player had no US changes. All four were suspected of having JK at the clinical examination.
Fourteen players had no knee symptoms according to the questionnaire. Among these asymptotic
Discussion
The main symptom of JK is insidious onset of pain in the knee, centred over the lower pole of the Patella–the pain usually resolving at rest. The condition usually deteriorates without treatment and can be graded as described by Roels et al., in 1978 (Nichols, 1992, Lian et al., 1996).
The diagnosis of JK was originally based on the patients own description of the knee pain and its relation to activity combined with tenderness when palpating the patellar tendon and the lack of both joint
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