Ultrasonographic assessment of quadriceps and patellar tendon thicknesses in patients with patellofemoral pain syndrome

Objective: The aim of this study was to compare ultrasonographically measured quadriceps and patellar tendon thicknesses between Patellofemoral Pain Syndrome (PFPS) patients and age- and gendermatched healthy controls. Methods: Among patients who presented to physical therapy and rehabilitation outpatient clinic in JanuaryeDecember 2016, 61 volunteers (28 men and 33 women; mean age: 30.79 ± 6.55 years) who were eligible considering the inclusion and exclusion criteria were enrolled. 30 were diagnosed with PFPS, and the remaining were age- and gender-matched healthy volunteers. Mean age was 30.03 ± 5.67 years in healthy subjects and 45.2% were of male gender. The patient group had mean age of 31.57 ± 7.37 years and 46.7% of the patients were male. Q angles were measured at standing, supine and sitting positions. Patellar and femoral tendon thicknesses and areas were measured ultrasonographically. Kujala questionnaire were used to evaluate the functional status of the participants. Results: No signiﬁcant difference was detected between groups regarding profession, educational background, and body mass indices (BMI) (p > 0.05). Q angle values were signiﬁcantly higher in the patient group when compared to controls at standing (17.03 ± 3.84 vs.13.87 ± 1.75,p< 0.001), supine (16.20 ± 3.74 vs.13.45 ± 1.79,p¼0.001) and sitting (16.50 ± 3.28 vs.13.71 ± 1.72,p< 0.001) positions. Kujala score was signiﬁcantly lower in the PFPS group when compared to controls (70.57 ± 8.37 vs. 98.58 ± 2.05, p < 0.001). Patellar (0.39 ± 0.08 vs. 0.32 ± 0.05 cm, p < 0.001) and quadriceps (0.64 ± 0.10 vs. 0.52 ± 0.09 cm, p < 0.001) tendon thicknesses were signiﬁcantly higher in the PFPS group when compared to controls. There was no signiﬁcant difference between groups regarding patellar tendon areas (p > 0.05). Patellar tendon thickness values of 0.35 cm were found to have 66.7% sensitivity and 67.7% speciﬁcity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.771, 95% conﬁdence interval: 0.655e0.887, p < 0.001). Quadriceps tendon thickness values of 0.54 cm were found to have 80% sensitivity and 71% speciﬁcity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.824, 95% conﬁdence interval: 0.710e0.939, p < 0.001). In PFPS patients, quadriceps tendon thickness had signiﬁcant positive correlation with age (r ¼ 0.405, p ¼ 0.027) and BMI (r ¼ 0.450, p ¼ 0.013); and signiﬁcant negative correlation with Kujala score (r ¼0.441, p ¼ 0.015). In the multivariate regression analysis, quadriceps tendon thickness was independently associated with the presence of PFPS (Exp (B): 3.089, 95% conﬁdence interval: 1.344e7.100, p ¼ 0.008). Conclusion: Our study demonstrates that ultrasonographically measured patellar and quadriceps tendon thicknesses are signiﬁcantly higher in subjects with PFPS and particularly, quadriceps tendon thickness may be used for the diagnosis.

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