Score Echogenicity Fiber pattern/alignment Size of ligament
0 Anechoic area
(central core lesion)
Lacking of parallel pattern
Acute injury (haemorrhage),
0-25% FA
Enlarged width and thickness
1 Lesion site starting to fill with presence of hypo-echoic areas, and moderate diffuse decrease in echogenicity Lacking of nice parallel pattern,
0-25% FA
Enlarged width and thickness
2 Lesion site gradually filling with presence of multiple areas with decreased echogenicity Increased parallel pattern,
25-50% FA
Enlarged width and thickness
3 Demarcation between injured and uninjured tendon less distinct,
Hypo-echoic areas are remaining
Increased parallel pattern,
25-50% FA
Mild enlarged width and thickness
4 Hardly any demarcation between injured and healthy tissue,
Faint signs of hypo-echoic areas
Close to total fiber alignment,
75-100% FA
Almost no enlarged width and thickness
5 Echogenicity (almost) identical to contralateral ligament Close to total fiber alignment,
75-100% FA
No enlarged width and thickness
Table 1: The scoring system used to evaluate and compare the ultrasound images in the present study. Different parameters such as echogenicity, fiber pattern/alignment (FA) grading, and size (width and thickness) of the ligament were considered and compared to the contralateral limb.