Reliability and Validity of Ultrasonography for Measurement of Hamstring Muscle and Tendon Cross-Sectional Area

The purpose of this study was to determine the reliability and validity of ultrasonography for measurement of hamstring muscle and semitendinosus (ST) tendon cross-sectional area (CSA). On two consecutive days, muscle anatomical CSA (ACSA) and ST tendon CSA were measured at standardized positions (30%-80% of thigh length; half the distance from the distal muscle-tendon junction to the popliteal crease) on 12 legs using ultrasonography and compared with corresponding magnetic resonance imaging measures. Inter-day intraclass correlation coefficients were good-to-excellent (0.882-0.996) for all assessed muscle and tendon sites. The limits of agreement widths were narrowest (range: 17%-52%) when muscle ACSA was large but were wide at sites with relatively small ACSA (≤184%) and for ST tendon CSA (range: 72%). Results suggest ultrasound-based measures of individual hamstring muscle maximal ACSA are reliable and valid and ST tendon CSA measures are reliable but require comparison with cadaveric or intra-operative measurements to verify validity.