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Updated: Jan 31, 2026

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Reliability and Repeatability of Diffusion Tensor Imaging in Healthy and Pathological Patellar Tendons.

Elizabeth A Schmida1,2, Ethan Hansen1,2, Daniel E O'Brien1,2

  • 1Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
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PubMed
Summary

Diffusion tensor imaging (DTI) offers reliable patellar tendon microstructure assessment. While inter-rater reliability is excellent, test-retest repeatability varies between pathological and healthy tendons.

Keywords:
anterior cruciate ligamentmicrostructurerehabilitationtendinopathy

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Area of Science:

  • Musculoskeletal imaging
  • Orthopedic research
  • Biomedical engineering

Background:

  • Patellar tendinopathy and anterior cruciate ligament reconstruction impact knee health.
  • Diffusion tensor imaging (DTI) is a non-invasive MRI technique for assessing tendon microstructure.

Purpose of the Study:

  • To evaluate the inter-rater reliability of DTI segmentations.
  • To assess the test-retest repeatability of DTI metrics in pathological and contralateral patellar tendons.

Main Methods:

  • Ten participants underwent two bilateral knee MRI scans within seven days.
  • DTI data were acquired and analyzed for regional scalar metrics (diffusivities, fractional anisotropy).
  • Intraclass correlations (ICCs) were calculated for inter-rater reliability and test-retest repeatability.

Main Results:

  • Excellent inter-rater reliability (ICCs 0.920–0.994) was found for all DTI metrics.
  • Test-retest repeatability was poor to moderate in pathological tendons (ICCs 0.164–0.709).
  • Repeatability was moderate to good in contralateral tendons (ICCs 0.566–0.842).

Conclusions:

  • DTI provides a reliable method for capturing patellar tendon microstructure.
  • Further research is needed to understand the clinical implications of altered DTI metrics in pathological tendons.