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The interrater reliability of ultrasonography for Achilles tendon structure

Marc Paantjens
Marc Paantjens
, 
Marco Leeuw
Marco Leeuw
, 
Pieter Helmhout
Pieter Helmhout
, 
Amanda Isaac
Amanda Isaac
 y 
Michel De Maeseneer
Michel De Maeseneer
   | 31 mar 2020
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Article Category: research-article
Publicado en línea: 31 mar 2020
Páginas: 6 - 11
Recibido: 30 dic 2019
Aceptado: 03 feb 2020
DOI: https://doi.org/10.15557/jou.2020.0002
Palabras clave
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

The Bland-Altman plot graphically visualizes the differences between observers 1 and 2 in measuring the Achilles tendon short-axis diameter. The paired differences are plotted against the mean difference for both observers (solid horizontal black line). The two broken red lines represent the upper and lower 95% limit of agreement (LOA). The mean difference between observers was -0.004 cm (95% CI: -0.009, 0.001), the lower LOA was -0.066 cm (95% CI: -0.075, -0.057) and the upper LOA was 0.058 cm (95% CI: 0.049, 0.067). SD – standard deviation; LOA – limits of agreement; CI – confidence interval
The Bland-Altman plot graphically visualizes the differences between observers 1 and 2 in measuring the Achilles tendon short-axis diameter. The paired differences are plotted against the mean difference for both observers (solid horizontal black line). The two broken red lines represent the upper and lower 95% limit of agreement (LOA). The mean difference between observers was -0.004 cm (95% CI: -0.009, 0.001), the lower LOA was -0.066 cm (95% CI: -0.075, -0.057) and the upper LOA was 0.058 cm (95% CI: 0.049, 0.067). SD – standard deviation; LOA – limits of agreement; CI – confidence interval

Fig. 2.

The Bland-Altman plot graphically visualizes the differences between observers 1 and 2 in measuring the Achilles tendon long-axis diameter. The paired differences are plotted against the mean difference for both observers (solid horizontal black line). The two broken red lines represent the upper and lower 95% LOA. The mean difference between observers was 0.003 cm (95% CI: -0.002, 0.008), the lower LOA was -0.06 cm (95% CI: -0.07, -0.05) and the upper LOA was 0.07 cm (95% CI: 0.06, 0.08). SD – standard deviation; LOA – limits of agreement; CI – confidence interval
The Bland-Altman plot graphically visualizes the differences between observers 1 and 2 in measuring the Achilles tendon long-axis diameter. The paired differences are plotted against the mean difference for both observers (solid horizontal black line). The two broken red lines represent the upper and lower 95% LOA. The mean difference between observers was 0.003 cm (95% CI: -0.002, 0.008), the lower LOA was -0.06 cm (95% CI: -0.07, -0.05) and the upper LOA was 0.07 cm (95% CI: 0.06, 0.08). SD – standard deviation; LOA – limits of agreement; CI – confidence interval

Fig. 3.

MSU image of a volunteer with Öhberg score 0, short-axis view (++ anterior and posterior border of the Achilles tendon). The tendon structure was graded as normal with homogeneous echogenicity
MSU image of a volunteer with Öhberg score 0, short-axis view (++ anterior and posterior border of the Achilles tendon). The tendon structure was graded as normal with homogeneous echogenicity

Fig. 4.

MSU image of a volunteer with Öhberg score 0, long-axis view (++ anterior and posterior border of the Achilles tendon). The tendon structure was graded as normal with homogeneous echogenicity
MSU image of a volunteer with Öhberg score 0, long-axis view (++ anterior and posterior border of the Achilles tendon). The tendon structure was graded as normal with homogeneous echogenicity

Fig. 5.

Short-axis view of an MSU image in which observer 1 graded the Öhberg score as 3, while observer 2 graded the Öhberg score as 2 (++ anterior and posterior border of the Achilles tendon). Discriminating severe structural changes (extended hypoechogenic areas) from moderate structural changes (some well-defined hypoechogenic areas) turned out to be difficult in this subject
Short-axis view of an MSU image in which observer 1 graded the Öhberg score as 3, while observer 2 graded the Öhberg score as 2 (++ anterior and posterior border of the Achilles tendon). Discriminating severe structural changes (extended hypoechogenic areas) from moderate structural changes (some well-defined hypoechogenic areas) turned out to be difficult in this subject

Fig. 6.

Long axis view of an MSU image in which observer 1 graded the Öhberg score as 3, while observer 2 graded the Öhberg score as 2. Discriminating severe structural changes (extended hypoechogenic areas) from moderate structural changes (some well-defined hypoechogenic areas) turned out to be difficult in this subject
Long axis view of an MSU image in which observer 1 graded the Öhberg score as 3, while observer 2 graded the Öhberg score as 2. Discriminating severe structural changes (extended hypoechogenic areas) from moderate structural changes (some well-defined hypoechogenic areas) turned out to be difficult in this subject

Demographics (n = 74, 148 Achilles tendons)

Mean* Range
Age (years) 33 ± 11.7 18-59
Height (cm) 183 ± 6.2 164-199
Weight (kg) 85 ± 10.7 63-120
BMI 25.4 ± 2,3 21-31

The distribution of the pattern of the Achilles tendon structure for two observers using the Öhberg score (n = 74, 148 Achilles tendons)

Observer 1 Observer 2
Öhberg score Tendons (n=) % of 148 tendons Tendons (n=) % of 148 tendons
0 120 81.1 124 83.8
1 23 15.5 18 12.2
2 3 1.4 6 4.1
3 2 1.4 0 0.0
Total 148 100 148 100

MSU measurements of the Achilles tendon anteroposterior diameter (n = 74, 148 Achilles tendons)

Short axis Long axis
Thickness (mm) Mean* Range (mm) Min-Max Thickness (mm) Mean* Range (mm) Min-Max
Observer 1 5.0 (4.9, 5.2) 3.7-10.6 5.0 (4.8, 5.2) 3.5-11.4
Observer 2 5.1 (4.9, 5.2) 3.7-10.9 5.0 (4.8,5.1) 3.2-11.1
Combined 5.1 (4.9, 5.2) 3.7-10.9 5.0 (4.9,5.1) 3.2-11.4

The modified four-graded öhberg score for Achilles tendon structure and neovascularization10

Öhberg score for Achilles tendon structure Öhberg score for neovascularization
0 Normal structure (homogeneous echogenicity) No neovascularization
1 Light structural changes (discrete hypoechogenic areas) Mild neovascularization (a few solitary blood vessels)
2 Moderate structural changes (some well-defined hypoechogenic areas) Moderate neovascularization (moderate quantity, most transversal blood vessels)
3 Severe structural changes (extended hypoechogenic areas) Severe neovascularization (several, mostly horizontal blood vessels spread in the whole depth of the tendon)
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