7 133 Normative Ultrasound Values for Achilles Tendon Thickness: An International Study measure when assessing Achilles tendon geometry, it doesn’t fully capture the geometry of the tendon. Future research could focus on obtaining normative values for different measures of tendon geometry (e.g. cross-sectional area and volume) as well as for tendon structure. Second, we predefined fusiform Achilles tendon thickening as an exclusion criterion for asymptomatic participants. This might jeopardize generalizability, as there might be persons without (previous) Achilles tendon pain but a local thickened tendon. This might have overestimated the difference in ultrasonographic tendon thickness between asymptomatic and symptomatic individuals. We acknowledge this, but we feel that this choice was justified as one of the diagnostic criteria for AT is localized tendon thickening. Third, we used the UTC procedure to obtain ultrasonographic values for Achilles tendon thickness. It is questionable whether the results of this sophisticated procedure can be extrapolated to the procedures using conventional ultrasound in daily clinical practice. Nevertheless, we have recently showed a clear agreement (ICC 0.95) in obtained Achilles tendon thickness between the UTC procedure and conventional ultrasound procedure in the clinical setting.25 PERSPECTIVE Achilles tendon thickness is influenced by personal characteristics with older age and higher height being associated with increased values for Achilles tendon thickness. The normative ultrasonographic values for tendon thickness derived from this study can help clinicians to differentiate between physiological morphological changes and features consistent with Achilles tendinopathy. The openly accessible web-based calculator for normative values of Achilles tendon thickness adjusted by personal characteristics can be accessed at www.achillestendontool.com and may help clinicians to distinguish between ultrasonographic features of Achilles tendinopathy and normal morphological changes.
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