Reliability of sonoelastography measurements of lower limb tendon properties: a systematic review

Alessandro Schneebeli, Anna Folli, Deborah Falla, Marco Barbero

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This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.

Original languageEnglish
Pages (from-to)1131-1150
JournalUltrasound in Medicine & Biology
Issue number5
Early online date28 Jan 2021
Publication statusE-pub ahead of print - 28 Jan 2021

Bibliographical note

Funding Information:
We thank Matteo Beretta-Piccoli for the methodological support. The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Publisher Copyright:
© 2020 World Federation for Ultrasound in Medicine & Biology

Copyright 2021 Elsevier B.V., All rights reserved.


  • Achilles tendon
  • Elastography
  • Patellar tendon
  • Quadriceps tendon
  • Shear-wave sonoelastography
  • Strain sonoelastography

ASJC Scopus subject areas

  • Biophysics
  • Radiological and Ultrasound Technology
  • Acoustics and Ultrasonics


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