The interrater reliability of ultrasonography for Achilles tendon structure

Paantjens, Marc; Leeuw, Marco; Helmhout, Pieter; Isaac, Amanda; Maeseneer, Michel De

doi:10.15557/jou.2020.0002

Abstract

Aim of the study: Reliable assessment of Achilles tendon structure (architecture and morphology) may help prevent clinical symptoms or progression of Achilles tendinopathy. The objective of this study was to determine the interrater reliability of musculoskeletal ultrasonography for the assessment of the mid-portion of the Achilles tendon: (1) structure, (2) anteroposterior diameter and (3) neovascularization, in asymptomatic military personnel. Material and methods: Two sonographers acquired B-mode images of the Achilles tendon mid-portion in 74 volunteers (148 tendons) in short-axis and long-axis planes to assess its structure and measure the maximum anteroposterior diameter. Power Doppler ultrasound was performed to assess neovascularization. Tendon structure and neovascularization were graded using a modified four-graded Öhberg score. Results: Weighted kappa for assessing tendon structure showed almost perfect agreement (0.87; 95% CI: 0.79, 0.95). Spearman’s rho showed: a very high positive interobserver correlation for tendon structure (0.92; 95% CI: 0.89, 0.94), a very high positive interobserver correlation for the diameter measurement in the short-axis plane (0.91; 95% CI: 0.87, 0.93) and a high positive interobserver correlation in the long-axis plane (0.87; 95% CI: 0.83, 0.91). The Wilcoxon signed-rank test showed no significant differences between observers during diameter measurements (p value >0.05). Both sonographers reported absent neovascularization in all the subjects, resulting in overall Öhberg score of 0. Conclusions: (1) Interrater reliability of ultrasonography for grading the mid-portion Achilles tendon structure shows almost perfect agreement, and (2) ultrasonography is highly reliable in measuring the anteroposterior diameter. (3) In a large group of asymptomatic service members neovascularization of the Achilles tendon is consistently absent.

References

Kujala UM, Sarna S, Kaprio J: Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 2005; 15: 133–135.
Search in Google Scholar Back to article
Maffulli N, Khan KM, Puddu G: Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14: 840–843.
Search in Google Scholar Back to article
de Jonge S, van den Berg C, de Vos RJ, van der Heide HJ, Weir A, Verhaar JA et al.: Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med 2011; 45: 1026–1028.
Search in Google Scholar Back to article
Alfredson H, Lorentzon R: Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med 2000; 29: 135–146.
Search in Google Scholar Back to article
Owens BD, Wolf JM, Seelig AD, Jacobson IG, Boyko EJ, Smith B et al.: Risk factors for lower extremity tendinopathies in military personnel. Orthop J Sports Med 2013; 1: 2325967113492707.
Search in Google Scholar Back to article
Cook JL, Rio E, Purdam CR, Docking SI: Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med 2016; 50: 1187–1191.
Search in Google Scholar Back to article
McAuliffe S, McCreesh K, Culloty F, Purtill H, O’Sullivan K: Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med 2016; 50: 1516–1523.
Search in Google Scholar Back to article
Kannus P, Józsa L: Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73: 1507–1525.
Search in Google Scholar Back to article
Bleakney RR, White LM: Imaging of the Achilles tendon. Foot Ankle Clin 2005; 10: 239–254.
Search in Google Scholar Back to article
Sunding K, Fahlström M, Werner S, Forssblad M, Willberg L: Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1988–1996.
Search in Google Scholar Back to article
Bujang MA, Baharum N: Guidelines of the minimum sample size requirements for Cohen’s Kappa. Epidemiolog Biostat Public Health 2017; 14: 1–10.
Search in Google Scholar Back to article
Scott A, Backman LJ, Speed C: Tendinopathy: Update on pathophysiology. J Orthop Sports Phys Ther 2015; 45: 833–841.
Search in Google Scholar Back to article
Beggs I, Bianchi S, Bueno A, Cohen M, Court-Payen M, Grainger A et al.: Musculoskeletal ultrasound technical guidelines VI. Ankle. Online: https://essr.org/content-essr/uploads/2016/10/ankle.pdf (Accessed: 29.12.2019).
Search in Google Scholar Back to article
Marsaglia G, Tsang WW, Wang J: Evaluating Kolmogorov’s distribution. J Stat Soft 2003; 8: 1–4.
Search in Google Scholar Back to article
Bishara AJ, Hittner JB: Testing the significance of a correlation with nonnormal data: Comparison of Pearson, Spearman, transformation, and resampling approaches. Psychol Methods 2012; 17: 399–417.
Search in Google Scholar Back to article
Viera AJ, Garrett JM: Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37: 360–363.
Search in Google Scholar Back to article
Bland JM, Altman DG: Agreed statistics: measurement method comparison. Anesthesiology 2012: 116: 182–185.
Search in Google Scholar Back to article
Johannsen F, Jensen S, Stallknecht SE, Olsen LO, Magnusson SP: Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test-retest intra- and intertester study. J Clin Ultrasound 2016; 44: 480–486.
Search in Google Scholar Back to article
Nicol AM, McCurdie I, Etherington J: Use of ultrasound to identify chronic Achilles tendinosis in an active asymptomatic population. J R Army Med Corps 2006; 152: 212–216.
Search in Google Scholar Back to article
de Jonge S, Warnaars JL, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM et al.: Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports 2014; 24: 773–778.
Search in Google Scholar Back to article
De Marchi A, Pozza S, Cenna E, Cavallo F, Gays G, Simbula L et al.: In Achilles tendinopathy, the neovascularization, detected by contrast-enhanced ultrasound (CEUS), is abundant but not related to symptoms. Knee Surg Sports Traumatol Arthrosc 2018; 26: 2051–2058.
Search in Google Scholar Back to article
Yang X, Pugh ND, Coleman DP, Nokes LD: Are Doppler studies a useful method of assessing neovascularisation in human Achilles tendinopathy? A systematic review and suggestions for optimizing machine settings. J Med Eng Technol 2010; 34: 365–372.
Search in Google Scholar Back to article
Cook JL, Malliaras P, De Luca J, Ptasznik R, Morris ME, Goldie P: Neovascularization and pain in abnormal patellar tendons of active jumping athletes. Clin J Sport Med 2004; 14: 296–299.
Search in Google Scholar Back to article
van Snellenberg W, Wiley JP, Brunet G: Achilles tendon pain intensity and level of neovascularization in athletes as determined by color Doppler ultrasound. Scand J Med Sci Sports 2007; 17: 530–534.
Search in Google Scholar Back to article
O’Brien M: The anatomy of the Achilles tendon. Foot Ankle Clin 2005; 10: 225–238.
Search in Google Scholar Back to article

The interrater reliability of ultrasonography for Achilles tendon structure

Abstract

Paradigm

My account