6 115 Ultrasonographic Achilles Tendon Thickness: Insertional vs. Midportion Reliability Next to this, the UTC data collection procedure in both groups was only performed by one rater. Consequently, we did not obtain data on the reliability of the UTC procedure itself. The finding of excellent to good reliability in translation from UTC measurements to conventional US makes it less likely that the UTC procedure itself has a large influence, which is confirmed by previous studies showing excellent reliability of the UTC scanning procedure.27,34 Future perspectives Future research should focus on obtaining a large dataset of reference values for Achilles tendon thickness in asymptomatic individuals in order to adequately distinguish between changes characteristic of tendinopathy (increased tendon thickening) and ‘normal’ morphological appearance. The SRD values in both the midportion and insertional region identified in the current study will aid in interpreting these between-group differences. This will likely have a major impact on interpreting US assessment for patients with AT. CONCLUSION This study offers valuable insights into the reliability of US-based thickness measurements in patients with Achilles tendinopathy and individuals with asymptomatic Achilles tendons. We showed excellent reliability for accurately measuring the US thickness of the midportion and good reliability of measuring the insertional region in patients with Achilles tendinopathy. Significantly lower ICC and higher SRD values were observed for the reliability of thickness measurements in the insertional region when compared to the midportion. As the SRD values exceed the mean difference in tendon thickness between insertional AT patients and asymptomatic individuals, we recommend interpreting US thickness with caution in patients with insertional Achilles tendinopathy. Thickness measurements with the standardized US (UTC) procedure were similar to conventional US. In order to accurately discriminate between changes indicative of tendinopathy, such as increased tendon thickening, and morphological changes that fall within the range of normal variation, future research should prioritize the acquisition of ultrasonographic reference values for tendon thickness in symptomatic and asymptomatic individuals. This will likely impact on the role of US in assessing patients with AT. SUPPLEMENTARY MATERIAL All supplementary information is available online at: https://onlinelibrary.wiley.com/doi/ full/10.1002/jum.16396
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