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Abstract
Objective: Evaluate intra- and inter-observer variation in the presence of enthesophytes in patients with insertional Achilles tendinopathy on radiographic (X-ray) and magnetic resonance imaging (MRI) images. Methods: We selected X-ray and MRI images of 20 patients diagnosed with an injury. We sent a questionnaire to five foot and ankle surgeons and five radiologists. We obtained answers about diagnosis accuracy and the presence of insertional enthesophytes (bone spurs). Results: Intra-observer agreement with regards to diagnosis accuracy in the MRI analysis was a K of 0.77 (0.62 to 1.00), while in the X-ray analysis, the K was 0.95 (0.77 to 1.00). Intra-observer agreement on the presence of enthesophytes in the MRI analysis had a K coefficient of 0.90 (0.68 to 1.00) and intra-observer agreement in the X-ray of 0.93 (0.86 to 1.00). The evaluation of inter-observer agreement on the diagnosis accuracy had a K coefficient between 0.09 and 0.20. Inter-observer agreement regarding the presence of enthesophytes was a K value between 0.59 and 0.63 for the MRI and a K between 0.81 and 0.82 for the X-ray results. Conclusion: Intra-observer values for diagnosis accuracy of the MRI and X-ray tests indicated strong to almost perfect agreement, similar to the intra-observer values for evaluation of the presence of enthesophytes, but the X-ray had better agreement. In both tests, intra-observer agreement on the presence of osteophytes was weak in comparison to inter-observer agreement, yet in the inter observer evaluation of the presence of enthesophytes, the X-ray agreement was greater than the MRI values. Level of Evidence III; Diagnostic Study.
Highlights
6% of the general population will develop insertional Achilles tendinopathy at some point in life[1]
Intra-observer agreement on the presence of osteophytes was weak in comparison to inter-observer agreement, yet in the inter-observer evaluation of the presence of enthesophytes, the X-ray agreement was greater than the magnetic resonance imaging (MRI) values
Imaging test results of 20 patients diagnosed with Achilles insertional tendinopathy and the presence of enthesophytes were evaluated
Summary
6% of the general population will develop insertional Achilles tendinopathy at some point in life[1]. The condition has a bimodal distribution, is more common in athletes, and represents 6-17% of all injuries in this group. It can be present in middle-aged, overweight patients who are non-athletes and have no history of physical activity[2]. Achilles tendinopathy is characterized by pain, functional limitation and swelling around the tendon. It can be classified as an insertional and non- insertional tendinopathy, two distinct pathologies with diffe rent pathophysiology and treatment options[4]. The middle and insertional portions of the tendon are morphologically, functionally and physiologically different in their normal state. At the onset of the pathology, changes in the cell matrix are indistinguishable and the pathophysiology appears to be
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