Skip to main content
NCBI home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2001 Feb;35(1):65–69. doi: 10.1136/bjsm.35.1.65

Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

J Cook 1, K Khan 1, Z Kiss 1, C Purdam 1, L Griffiths 1
PMCID: PMC1724272  PMID: 11157466

Abstract

Background—Palpation is an important clinical test for jumper's knee.

Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality.

Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively.

Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01).

Conclusions—In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Key Words: patellar tendon; ultrasound; palpation; reliability; athletes

Full Text

The Full Text of this article is available as a PDF (118.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbuti D., Bergami G., Testa F. Aspetti ultrasonografici della malattia di Sinding-Larsen-Johansson. Pediatr Med Chir. 1995 Jan-Feb;17(1):61–63. [PubMed] [Google Scholar]
  2. Colosimo A. J., Bassett F. H., 3rd Jumper's knee. Diagnosis and treatment. Orthop Rev. 1990 Feb;19(2):139–149. [PubMed] [Google Scholar]
  3. Cook J. L., Khan K. M., Harcourt P. R., Kiss Z. S., Fehrmann M. W., Griffiths L., Wark J. D. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med. 1998 Apr;8(2):73–77. doi: 10.1097/00042752-199804000-00001. [DOI] [PubMed] [Google Scholar]
  4. Cook J. L., Khan K. M., Kiss Z. S., Griffiths L. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports. 2000 Aug;10(4):216–220. doi: 10.1034/j.1600-0838.2000.010004216.x. [DOI] [PubMed] [Google Scholar]
  5. Cook J. L., Khan K. M., Kiss Z. S., Purdam C. R., Griffiths L. Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players. J Ultrasound Med. 2000 Jul;19(7):473–479. doi: 10.7863/jum.2000.19.7.473. [DOI] [PubMed] [Google Scholar]
  6. Davies S. G., Baudouin C. J., King J. B., Perry J. D. Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis. Clin Radiol. 1991 Jan;43(1):52–56. doi: 10.1016/s0009-9260(05)80355-1. [DOI] [PubMed] [Google Scholar]
  7. Duri Z. A., Aichroth P. M. Patellar tendonitis: clinical and literature review. Knee Surg Sports Traumatol Arthrosc. 1995;3(2):95–100. doi: 10.1007/BF01552382. [DOI] [PubMed] [Google Scholar]
  8. Fritschy D., Panoussopoulos A., Wallensten R., Peter R. Can we predict the outcome of a partial rupture of the anterior cruciate ligament? A prospective study of 43 cases. Knee Surg Sports Traumatol Arthrosc. 1997;5(1):2–5. doi: 10.1007/s001670050015. [DOI] [PubMed] [Google Scholar]
  9. Gibbon W. W., Cooper J. R., Radcliffe G. S. Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis. Br J Sports Med. 1999 Apr;33(2):129–130. doi: 10.1136/bjsm.33.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kannus P., Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991 Dec;73(10):1507–1525. [PubMed] [Google Scholar]
  11. Khan K. M., Bonar F., Desmond P. M., Cook J. L., Young D. A., Visentini P. J., Fehrmann M. W., Kiss Z. S., O'Brien P. A., Harcourt P. R. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology. 1996 Sep;200(3):821–827. doi: 10.1148/radiology.200.3.8756939. [DOI] [PubMed] [Google Scholar]
  12. Khan K. M., Cook J. L., Bonar F., Harcourt P., Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999 Jun;27(6):393–408. doi: 10.2165/00007256-199927060-00004. [DOI] [PubMed] [Google Scholar]
  13. Khan K. M., Cook J. L., Kiss Z. S., Visentini P. J., Fehrmann M. W., Harcourt P. R., Tress B. W., Wark J. D. Patellar tendon ultrasonography and jumper's knee in female basketball players: a longitudinal study. Clin J Sport Med. 1997 Jul;7(3):199–206. doi: 10.1097/00042752-199707000-00009. [DOI] [PubMed] [Google Scholar]
  14. Laine H. R., Harjula A., Peltokallio P. Ultrasound in the evaluation of the knee and patellar regions. J Ultrasound Med. 1987 Jan;6(1):33–36. doi: 10.7863/jum.1987.6.1.33. [DOI] [PubMed] [Google Scholar]
  15. Leadbetter W. B. Cell-matrix response in tendon injury. Clin Sports Med. 1992 Jul;11(3):533–578. [PubMed] [Google Scholar]
  16. Micheli L. J. The traction apophysitises. Clin Sports Med. 1987 Apr;6(2):389–404. [PubMed] [Google Scholar]
  17. Mourad K., King J., Guggiana P. Computed tomography and ultrasound imaging of jumper's knee-patellar tendinitis. Clin Radiol. 1988 Mar;39(2):162–165. doi: 10.1016/s0009-9260(88)80017-5. [DOI] [PubMed] [Google Scholar]
  18. Nirschl R. P. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992 Oct;11(4):851–870. [PubMed] [Google Scholar]
  19. Roels J., Martens M., Mulier J. C., Burssens A. Patellar tendinitis (jumper's knee). Am J Sports Med. 1978 Nov-Dec;6(6):362–368. doi: 10.1177/036354657800600609. [DOI] [PubMed] [Google Scholar]
  20. Soila K., Karjalainen P. T., Aronen H. J., Pihlajamäki H. K., Tirman P. J. High-resolution MR imaging of the asymptomatic Achilles tendon: new observations. AJR Am J Roentgenol. 1999 Aug;173(2):323–328. doi: 10.2214/ajr.173.2.10430128. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES