Improving clinical evaluation and decision-making in military personnel with mid-portion Achilles tendinopathy: Focusing on Ultrasound Tissue Characterization

Abstract

Chapter 1: Introduction We aimed to improve the clinical evaluation and decision-making process in military healthcare aimed at personnel with Achilles tendinopathy (AT), primarily focusing on mid-portion Achilles tendinopathy (mid-AT). Six studies were undertaken, with three core themes being the subject of research: I. ultrasonographical assessment of mid-portion tendon structure; II. clinical effectiveness of extracorporeal shockwave therapy (ESWT); III. thresholds on the Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire. The primary objective was to evaluate ultrasound tissue characterization (UTC) as an outcome measure for mid-AT. Chapter 2: Inter-rater reliability of ultrasonography for Achilles tendon structure. In asymptomatic subjects, conventional ultrasonography showed: 1. almost perfect agreement in grading mid-portion tendon structure (kw 0.87, 95% CI: 0.79, 0.95); 2. a very high inter-observer correlation in measuring mid-portion diameter in short-axis plan