The role of ultrasound in the diagnosis and management of jumpers’ knee; A critical review
Matthew Hicks1 Gill Dolbear2, 1Elizabeth Hospital, Kings Lynn, 2Canterbury Christ Church University
Jumpers’ Knee is a term used to describe tendonitis or tendinopathy of the patellar tendon, as it is most prevalent following participation in sports such as jumping, basketball, football and volleyball (Rudavsky & Cook, 2014).
The phrase tendonitis has been in decline following the study by Maffulli et al (1998) that suggested inflammatory responses had little involvement in tendinopathic changes. In 2009 Cook and Purdam introduced the concept of tendinopathy as a dynamic process, with areas of a single tendon in different stages at any given time. More recently, a large systematic literature review by Dean et al (2017, p.5) considered the evidence of inflammation in tendinopathy to be “increasingly overwhelming in recent years”. Could the theory that surrounds the aetiology and pathogenesis of tendinopathy therefore be about to change once more?
Ultrasound aids clinical diagnosis by correlating B-mode and Doppler findings to patient symptoms. However, despite some claims, there seems little evidence that ultrasound findings can reliably predict the onset of Jumpers’ Knee at this moment in time.
The optimum imaging modality for accurately diagnosing or predicting tendinopathy may be Shear Wave Elastography (SWE), as De Zordo et al (2009) found a correlation between tendon stiffness and normal B-mode appearances, whilst Ooi et al (2015) found a correlation between SWE strain mapping and tendon thickness. More recently, Dirrichs et al (2016) performed a prospective study on 112 patients, in which the correlation between symptomatic tendons and low SWE values was found to be highly significant (P< 0.001); however, it remains to be seen if its use can be more reliable in predicting the onset of tendinopathy when compared to B-mode and Doppler ultrasound.