Nicola Maffulli1,2, Francesco Oliva3, Mattia Loppini4, Rocco Aicale1, Filippo Spiezia5, John B King2. 1. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy. 2. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospita, London, England. 3. Department of Orthopedics and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy. 4. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy. 5. Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy.
Abstract
PURPOSE: To ascertain whether the Royal London Hospital test is reproducible, sensitive, and specific for diagnosis of patellar tendinopathy. METHODS: Fifteen consecutive athletes with patellar tendinopathy were prospectively enrolled and compared with a control group of 15 non consecutive athletes with Achilles tendinopathy. Two testers examined separately each patient, using manual palpation and the Royal London Hospital test for diagnosis of patellar tendinopathy. High resolution real time ultrasonography was used as standard for diagnosis of tendinopathy and assessment of tendon thickness. RESULTS: The palpation test presented significantly higher sensitivity compared to the Royal London Hospital test (98 vs 88%; P=0.01); specificity was 94% for the palpation test and 98% for the Royal London Hospital test (P>0.05). Positive and negative predictive values were 94 and 98% for palpation test, 98 and 89% for the Royal London Hospital test, respectively. The two tests showed good to very good intra-tester and inter-tester agreement. At ultrasonography, pathological patellar tendons were significantly thicker compared to controlateral healthy tendon (P<0.001). CONCLUSIONS: In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed for a correct clinical diagnosis of patellar tendinopathy. Imaging assessment should be performed as a confirmatory test. LEVEL OF EVIDENCE: III.
PURPOSE: To ascertain whether the Royal London Hospital test is reproducible, sensitive, and specific for diagnosis of patellar tendinopathy. METHODS: Fifteen consecutive athletes with patellar tendinopathy were prospectively enrolled and compared with a control group of 15 non consecutive athletes with Achilles tendinopathy. Two testers examined separately each patient, using manual palpation and the Royal London Hospital test for diagnosis of patellar tendinopathy. High resolution real time ultrasonography was used as standard for diagnosis of tendinopathy and assessment of tendon thickness. RESULTS: The palpation test presented significantly higher sensitivity compared to the Royal London Hospital test (98 vs 88%; P=0.01); specificity was 94% for the palpation test and 98% for the Royal London Hospital test (P>0.05). Positive and negative predictive values were 94 and 98% for palpation test, 98 and 89% for the Royal London Hospital test, respectively. The two tests showed good to very good intra-tester and inter-tester agreement. At ultrasonography, pathological patellar tendons were significantly thicker compared to controlateral healthy tendon (P<0.001). CONCLUSIONS: In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed for a correct clinical diagnosis of patellar tendinopathy. Imaging assessment should be performed as a confirmatory test. LEVEL OF EVIDENCE: III.
Authors: Nicola Maffulli; Michael G Kenward; Vittorino Testa; Giovanni Capasso; Renato Regine; John B King Journal: Clin J Sport Med Date: 2003-01 Impact factor: 3.638
Authors: Lucas Maciel Rabello; I van den Akker-Scheek; Ireen F Kuipers; R L Diercks; Michel S Brink; J Zwerver Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-01 Impact factor: 4.342
Authors: Gil Rodas; Robert Soler; Ramón Balius; Xavier Alomar; Xavier Peirau; Mercedes Alberca; Ana Sánchez; Javier García Sancho; Clementina Rodellar; Antonio Romero; Lorenzo Masci; Lluís Orozco; Nicola Maffulli Journal: J Orthop Surg Res Date: 2019-12-16 Impact factor: 2.359