Background. The purpose of this study was to evaluate the reliability and validity of using US imaging for measuring Achilles tendon insertion area to the calcaneus. Methods. Sixteen cadaveric tendons were used to compare the agreement between Achilles tendon insertion length measurements from US images with actual measurements after dissection. In addition, test-retest reliability was performed on six healthy subjects for tendon insertion length (IL), before calcaneal bone cross-sectional area (CSA) and tendon insertion angle (IA). The reliability and validity of the measurements was analyzed with intra-class correlation coefficient (ICC) and standard error of measurement (SEM). Results. There were significant differences and poor to good agreement between US measurements and Anthropometric measurements. Using cadaveric tendons images, the measurements agreement between the observers were good to excellent for IL, bone-to-insertion length and width before calcaneal bone (ICC 2,4 =.784, .935, .952). Test-retest reliability was excellent for US measurements for tendon IL (ICC 2,4 =.977,SEM=0.53mm), bone to IL (ICC 2,4 =.96, SEM=0.44mm), width before calcaneal bone (ICC 2,4 =.946, SEM=0.51mm), CSA (ICC 2,4 =.918, SEM=5.93mm 2), and IA (ICC 2,4 =.933, SEM=1.9°) on healthy tendons. Conclusions. US imaging was found to be reliable and valid to determine IL, width, and CSA of the Achilles tendon. The use of US imaging to determine Achilles tendon insertional size may be beneficial for evaluating the structural changes on disease development and progression.
Objective Kinesiophobia has been proposed to influence recovery in patients with Achilles tendinopathy. However, whether there are differences in outcomes in patients with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in patients with Achilles tendinopathy and various levels of kinesiophobia. Methods This study was a secondary analysis of a prospective observational cohort study of 59 patients with Achilles tendinopathy. The patients were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33] [low TSK group], those with medium TSK scores [34–41] [medium TSK group], and those with high TSK scores [≥42] [high TSK group]). All patients were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. Results There were 16 patients (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3–25.4]), 28 patients (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5–30.8]), and 15 patients (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2–33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. Conclusion Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. Impact Evaluating the degree of kinesiophobia in patients with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
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