## 3 Results
### General Characteristics of the Studies Assessed
This was confirmed in some cases with surgical exploration [31]. The validity of the FMR test and the SHRT have been further confirmed in another study by MRI using the Movin score. However, when the tests are compared to each other, they show little significance [21]. Another study looked at the link between pain on palpation during a physical exam and PPTD findingsusing MRI and ultrasound. It concluded that pain on physical exam is strongly linked to tendonitis, but not to tendon tear. It also highlighted that US is less accurate in identifying tendon disruption [29]. The first ray mobility test was the only test found in the review that has been shown not to be correlated with PTTD [22]. * Imaging parameters Within the literature, the most-described method for assessment was imaging, including MRI, US, and radiographs. MRI has been described by many papers; many of them describe it to be the \"gold standard\" [20; 23; 26; 27]. Certain parameters using MRI are used to provide a positive diagnosis. One paper compared the cross-sectional area and the TP thickness, finding that TP cross-sectional area is the more sensitive measurement [19]. Another paper highlights that finding the pathology requires looking specifically at tenosynovial fluid rather than just intrasubstance TP pathology. Identifying a fluid width measuring greater than or equal to 9 mm is a predictor of stage 1 PTTD [20]. One study showed TP sheath fluid had modest specificity and fair-moderate sensitivity. The study also found excellent specificity and fair sensitivity for tibial spurring and unroofing of the talus. However, bone-bruise-like lesions were commonly seen both in the PTTD cases and in the control group [30]. US can also be used to assess subcutaneous swelling, which confirms the validity of the previous study, looking at swelling in a physical examination. A significant association between subcutaneous swelling and PTTD findings has been shown through US; therefore, more validation is provided for PTE [18]. MRI and Ultrasound comparison More recent papers have compared MRI to US. US has been shown to be highly efficient in detecting tears and inflammation in the tendon and is slightly more accurate than MRI. However, MRI can detect secondary signs of PTTD, such as bone marrow oedema, which US cannot. Furthermore, compared to surgical findings, both have demonstrated good accuracy [23]. However, another paper also found that US shows more false positives compared to MRI; therefore, it has been deemed to be less accurate [29]. One study found the correlation between surgical findings and MRI to be in 100% agreement with the diagnostics of type 1 PTTD, with 73% agreement in stage 2 and 60% agreement in stage 3; these results highlight that, perhaps, US imaging is more accurate in the earlier stages. The differences noted within these cases are between mixing partial tears and tendinosis [27]. Although some papers have identified US as being less accurate than MRI [29], it has also identified MRI and US to be comparable [27] or more accurate [23]. Furthermore, US has been deemed to have many advantages, as it is more convenient to use in clinics, it is cheaper, and it has the ability to be used to perform real-time examinations [27]. Radiographs One of the included studies compared MRI to radiographs. There was some correlation. However, as radiographs are only able to detect deformity, which is secondary to tendon tear and is neither tendinosis nor tenosynovitis, it is not as accurate as MRI or US [24]. Risk of Bias Most of the included studies presented a low risk of bias. However, the study from [PERSON] et al. in 2015 [23] presented a high risk of bias in five of the items, as per the QUADAS assessment. Most of the included studies (13 out of 15) presented a low risk of bias in the flow and timing domains and in the index test from the applicability concerns. On the other hand, eight of the included studies presented a high risk of bias in the patient selection domain (Table 2).