Patellar mobility can be reproducibly measured using ultrasound.

The present study was performed to examine the reliability of ultrasound in evaluating patellar mobility in the superior-inferior direction. Twelve healthy men volunteered for the study. Patellar mobility in the superior-inferior direction during isometric knee extension contraction with the knee immobilized in a semi-flexed knee brace was measured using ultrasound. Both intra-observer and inter-observer reliability were assessed by intra-class correlation coefficients (ICCs). Bland-Altman analysis was used for assessing agreement between measurements. ICC values were excellent for both intra-observer and inter-observer reliability at 0.97 and 0.93, respectively. In 95 % of measurements, the same observer measured within -0.55 to 0.61 mm, while different observers measured within -0.82 to 0.85 mm. In conclusion, patellar mobility in the superior-inferior direction during an isometric knee extension exercise can be reproducibly measured using ultrasound. THE LEVEL OF EVIDENCE: VI (basic study of a novel evaluation method).

Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation.

PURPOSE: Anterior knee pain related to the donor site is a frequent complication of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone autograft tissue. Even when hamstring tendon (HT) grafts are used instead, symptoms such as mild pain and discomfort can still occur. The purpose of this study was to elucidate the pathophysiology of anterior knee symptoms after ACLR with HT autografts. METHODS: Fifty-seven patients (22 men and 35 women; mean age, 24.7 years) who underwent anatomic double-bundle ACLR with HT autografts were examined 6 months post-operatively. The presence of anterior knee symptoms, anterior knee laxity, range of motion, and muscle strength were assessed. Changes in patellar tendon and infrapatellar fat pad (IFP) morphology and blood flow were also evaluated using ultrasound. Potential variables affecting the presence of anterior knee symptoms were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors. RESULTS: Six months post-operatively, the total incidence of anterior knee symptoms was 56.1 % (32/57). According to univariate analysis, age, quadriceps strength, and increased blood flow in the IFP were significantly associated with the presence of anterior knee symptoms. Multivariate logistic regression analysis revealed that increased blood flow in the IFP was an independent factor for the presence of anterior knee symptoms (odds ratio 5.0; 95 % confidence interval 1.3-19.9). There were no significant findings inside the patellar tendon. CONCLUSIONS: Increased blood flow in the IFP was identified as an independent factor for the presence of anterior knee symptoms 6 months after ACLR with HT autografts. The ultrasound evaluation can help to define precisely the origin of anterior knee symptoms after ACLR with HT autografts. LEVEL OF EVIDENCE: Case series with no comparison groups, Level IV.