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Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler

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journal contribution
posted on 26.01.2018 by James Watson, Rob Barker-Davies, Alexander N. Bennett, Daniel Fong, Patrick Wheeler, Mark Lewis, Craig A. Ranson
Objective. Several lower limb tendinopathy treatment modalities involve identification of pathological para- or intra-tendinous neovascularisation to target proposed colocation 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 amongst Sports and Exercise Medicine (SEM) consultants. This study aims to determine inter- 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 imaging by 6 SEM consultants who rated neovascular changes seen using the MOS. Representative digital scan images were saved for re-scoring 3 weeks later. Inter- 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- 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.


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



  • Sport, Exercise and Health Sciences

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BMJ Open Sport and Exercise Medicine


WATSON, J. ... et al, 2018. Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler. BMJ Open Sport and Exercise Medicine, 4 (1), e000298.


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This work is made available according to the conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/

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This is an Open Access Article. It is published by BMJ Publishing Group under the Creative Commons Attribution 4.0 International Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/.







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