Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy: A large international cross‐sectional study

The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior–posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior–posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th‐97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8–6.9) mm for the midportion region and 3.7 (2.8–4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation −2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was −0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × −0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3–3.2, p