Reliability of sonographic measurements of the ulnar collateral ligament: a multi-rater prospective study

BACKGROUND: The use of sonography is a cost-effective and reliable method to evaluate upper extremity superficial tissue structural integrity and pathology. Establishing the measurement reliability of widely used diagnostic ultrasound evaluation for musculoskeletal assessment is paramount enhance accurate clinical evaluations. The objective of this study was to establish the inter-rater and intra-rater reliability of select ulnar collateral ligament (UCL) thickness measures at two distinct anatomical locations in intercollegiate baseball athletes using ultrasound imaging (USI). METHODS: This was a prospective cohort study conducted in a university research laboratory and included a total of 17 NCAA Division I baseball athletes (age 20.4 ± 1.43, height = 183.63 cm ± 6.27 cm, mass = 89.28 kg ± 8.24 kg). Two trained clinicians measured UCL mid-substance and apex thickness in the throwing extremity, prospectively, on 5 occasions at 1-month intervals during rest. Intraclass correlation coefficients (ICCs) (model 3,3), associated standard error of measurement, and 95% minimal detectable change in thickness were derived. RESULTS: Intrarater reliability estimates for operator 1 were 0.90–0.98 (mid-substance) and 0.91–0.99 (apex). Operator 2’s values were 0.92–0.97 and 0.93–0.99, respectively. The standard error of measurement (SEM) ranged from 0.045–0.071 cm (mid-substance) and 0.023–0.067 cm (apex). The minimal detectable difference (MDD95) was 0.12–0.20 cm (mid-substance) and 0.07–0.19 cm (apex). Interrater reliability was 0.86–0.96 (mid-substance) and 0.79–0.98 (apex); most ICCs were >0.90. Measurement of UCL thickness at two locations demonstrated very good to excellent reliability with high precision. Using this protocol, two evaluators can obtain consistent UCL measurement at two positions. This finding has significant implications for the clinical evaluation of superficial tissue pathology of the same individual by two experienced practitioners.