Point-of-Care Ultrasound-based Characterization of the Patellar Tendon in Children with Cerebral Palsy

Mobility impairments caused by cerebral palsy (CP) negatively impact the daily lives of those with this neurodevelopmental disorder. The primary treatment method is physical therapy, which requires an understanding of the musculoskeletal system. While previous studies focus on muscles, tendons are also critical to movement and ambulatory activities. Therefore, this study aims to understand and quantitatively compare the patellar tendons of children with CP and their typically developing (TD) peers to guide physical therapy treatment.

The right patellar tendon of 20 children, 8 with CP and 12 TD, was imaged using a Clarius L7HD3 wireless ultrasound probe (Clarius Mobile Health, Vancouver, BC, Canada) in both the transverse and sagittal planes. The raw radiofrequency ultrasound data were analyzed to quantify differences in image quality, ultrasonic spectral parameters and envelope statistics between children with CP and their TD peers, both as a group and across age- and sex-matched pairings.

Significant and consistent differences were observed in 6 of the 10 investigated metrics, including contrast, contrast-to-noise ratio, signal-to-noise ratio, mid-band fit, spectral slope and Nakagami-m. One notable difference was observed in contrast, where the mean ± standard deviation in the transverse plane for children with CP was lower than that of their TD peers (1.66±4.43 vs. 5.14±5.37, respectively), indicating a statistically significant difference in echogenicity between the two groups. The observed trends in children with CP correlate with previous studies in injured tendons.

These results demonstrate the potential for point-of-care quantitative ultrasound-derived parameters to characterize patellar tendon microstructure and support personalized physical therapy assessment and treatment planning for children with CP.