7 129 Normative Ultrasound Values for Achilles Tendon Thickness: An International Study Table 1. Participant characteristics. Values are means with standard deviation (SD) or medians with interquartile ranges [IQR] unless otherwise described. *Midportion thickness included 64 patients with midportion AT. Insertional thickness included 34 patients with insertional AT. 2 patients had a combination of midportion and insertional AT. ** = 95% reference interval. † = adjusted for age, height, sex, BMI and physical activity level. ‡ = comorbidities include diabetes mellitus, hypertension, hypercholesterolemia, heart-vessel disease and thyroid disease Total Group (n=600) Achilles tendinopathy patients (n=100) Asymptomatic participants (n=500) Mean difference (95%CI, p-value) Age (years) 34 [23-53] 48.0 (12.8) 30 [22-50] 11.8 (8.4-15.2, p < 0.001 Height (cm) 174.9 (9.5) 178.6 (8.8) 174.2 (9.5) 4.4 (2.4-6.4, p < 0.001) BMI (kg/m2) 23.6 [21.826.2] 26.1 (4.5) 23.3 [21.7 – 25.6] 2.1 (1.3-2.9, p < 0,001) Sex (female/male/ undisclosed, n) 317/275/8 43/57 274/218/8 p = 0.020 Physical activity level (PAL; 1-6) 5 [4 - 6] 3 [3 – 4] 5 [4 - 6] p < 0.001 Symptom duration (weeks) - 108 [50-260] - - VISA-A score (0-100) - 48.0 (17.5) 98.9 (3.3) 50.9 (49.3 – 52.6, p < 0,001) Tendon thickness (mm; midportion) - 9.2 (2.5)* 4.9 [3.8 – 6.9]** 2.7 (2.3-3.2, p < 0.001)† Tendon thickness (mm; insertion) - 5.7 (1.4)* 3.7 [2.8 – 4.8]** 1.4 (1.1-1.7, p < 0.001)† Medication use (yes/no) 181/419 53/47 128/372 - Smoking (current/past/never) 33/67/500 5/34/61 28/33/439 - Presence of co-morbidities (yes/no)‡ 71/529 19/81 52/448 - Abbreviations; BMI: Body Mass Index (kg/m2), VISA-A: Victorian Institute of Sports Assessment-Achilles, AT: Achilles tendinopathy, PAL: Physical Activity Likert Scale; 1-6*, 1 = Hardly any physical activity, 2 = Mostly sitting, sometimes walk, easy tasks/play, 3 = Light physical activity for about 2-4 times a week (e.g., fishing, talking, dancing), 4 = Moderate exercise 1-2 hours a week (jogging, swimming, gymnastics), 5 = Moderate exercise at least 3 hours a week (jogging, swimming, gymnastics), 6 = Hard or very hard exercise regularly and several times a week during which the physical exercise is great (jogging, rugby, football). Normative values for Achilles tendon thickness There was no significant difference between the left and right leg for tendon thickness of the midportion region (5.06 vs 5.05 mm, p=0.728) and the insertional region (3.72 vs. 3.71 mm, p=0.967). Bivariate analyses revealed that age (r=0.46, p<0.001 and r=0.33, p<0.001), height (r=0.31, p<0.001 and r=0.34, p<0.001), BMI (r=0.17, p<0.001 and r=0.22, p<0.001) and sex (r=0.15, p<0.001 and r=0.25, p<0.001) had a correlation with maximum tendon thickness of the midportion and insertional region respectively. Leg dominance did not influence tendon thickness (r=0.032, p=0.48 for the midportion and r=0.007, p=0.87
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