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The interrater reliability of ultrasonography for Achilles tendon structure Cover

The interrater reliability of ultrasonography for Achilles tendon structure

Open Access
|Mar 2020

Figures & Tables

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 ± 11.718-59
Height (cm)183 ± 6.2164-199
Weight (kg)85 ± 10.763-120
BMI25.4 ± 2,321-31

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

Observer 1Observer 2
Öhberg scoreTendons (n=)% of 148 tendonsTendons (n=)% of 148 tendons
012081.112483.8
12315.51812.2
231.464.1
321.400.0
Total148100148100

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

Short axisLong axis
Thickness (mm) Mean* Range (mm) Min-MaxThickness (mm) Mean* Range (mm) Min-Max
Observer 15.0 (4.9, 5.2)3.7-10.65.0 (4.8, 5.2)3.5-11.4
Observer 25.1 (4.9, 5.2)3.7-10.95.0 (4.8,5.1)3.2-11.1
Combined5.1 (4.9, 5.2)3.7-10.95.0 (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 structureÖhberg score for neovascularization
0Normal structure (homogeneous echogenicity)No neovascularization
1Light structural changes (discrete hypoechogenic areas)Mild neovascularization (a few solitary blood vessels)
2Moderate structural changes (some well-defined hypoechogenic areas)Moderate neovascularization (moderate quantity, most transversal blood vessels)
3Severe structural changes (extended hypoechogenic areas)Severe neovascularization (several, mostly horizontal blood vessels spread in the whole depth of the tendon)
DOI: https://doi.org/10.15557/jou.2020.0002 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
Language: English
Page range: 6 - 11
Submitted on: Dec 30, 2019
Accepted on: Feb 3, 2020
Published on: Mar 31, 2020
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2020 Marc Paantjens, Marco Leeuw, Pieter Helmhout, Amanda Isaac, Michel De Maeseneer, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.