Congruency of Ultrasound Measure Changes Against Patient-Reported Outcome Measures in Patellar Tendinopathy: A Systematic Review and Meta-Analysis.

Abstract

Patellar tendinopathy is a highly prevalent clinical diagnosis supported by ultrasound changes. Numerous interventions are targeted at improving both symptoms and structure of dysfunctional tendons, however little is known of the diagnostic value in a changing ultrasound profile whilst patient-reported outcome measures (PROMs) determine recovery.The aim is to assess if changes in ultrasound measures are congruent with changes in Victorian Institute of Sports Assessment - Patella (VISA-P) scores, thereby supporting the use of ultrasound to assess patellar tendinopathy during symptom improvement. Four databases (PubMed, Web of Science, Embase, CINAHL) were searched in January 2019. Studies selected contained ultrasound and VISA-P scores from ≥ 2 type points. All included studies were quality assessed depending on the type and available data and underwent meta-analysis. A total of 10 papers of varying study types,limited to high quality, were synthesized. The meta-analysis indicated that changes in ultrasound measures were not congruent with changes in the VISA-P score. The variation in study quality, along with significant heterogeneity of ultrasound measure outcomes and reporting may influence the congruency of the data, but the association between gradual structure change and varying vascularity with pain or function is questionable throughout tendinopathy literature. The small study yield coupled with omission of data, along with alterations to form coherent analysis may impact outcomes, with an absence of homogeneity throughout studies. Ultrasound assessment is not useful in the follow-up of patellar tendinopathy after treatment and is of limited use as an indicator of normal function.