Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study.

BACKGROUND: A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery. PURPOSE: To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time. RESULTS: Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001). CONCLUSION: Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.

Ultrasound assessment of sarcopenia in patients with rheumatoid arthritis.

OBJECTIVES: To evaluate the efficacy of ultrasound (US) as a diagnostic tool for sarcopenia in patients with rheumatoid arthritis (RA). METHODS: Female RA patients aged >50 years and matched controls were cross-sectionally assessed. Sarcopenia was diagnosed based on the 2019-updated Asian Working Group for Sarcopenia definition. The cross-sectional area (CSA) and echo intensity (EI) of the biceps brachii, rectus femoris, and EI of the vastus lateralis were examined bilaterally. Correction for subcutaneous fat and calculation of the recorrected EI (rcEI) were performed. We performed logistic regression using both muscle rcEI and CSA with receiver operating curve analysis to evaluate the discriminative performance per muscle group. RESULTS: Seventy-eight consecutive RA patients and 15 age-and sex-matched controls were assessed. Sarcopenia was diagnosed in 34 RA patients (43.6%). The rcEI of examined muscles were significantly higher, whereas CSA were significantly lower in sarcopenic RA patients than in non-sarcopenic patients and matched controls. The combined discriminative performance of rcEI and CSA was superior to those of rcEI or CSA alone. CONCLUSIONS: This study suggests the use of US for the diagnosis of sarcopenia in RA patients. The diagnostic performance increases when both echogenicity and CSA are considered together rather than individually.

New scoring system in assessment of Hoffa's fat pad synovitis: A comparative study with established scoring systems.

AIM: To investigate the reliability of the established and new scoring methods for Hoffa's fat pad synovitis using magnetic resonance imaging (MRI). METHODS: A total of 139 knees of 115 patients who underwent MRI of the knee with and without gadolinium contrast were enrolled in this study. Proton density (PD)-weighted, PD-weighted fat-suppressed (PD-FS), and postcontrast T1-weighted fat-suppressed (T1CE) images were used for evaluation. Using contrast and non-contrast images, our grading method for synovitis was performed to measure synovial thickness and signal intensity changes of the fat pad [Synovial membrane (SM) score], which was compared with the established methods, including MRI Osteoarthritis Knee Score (MOAKS), parapatellar synovitis score, Whole-Organ Magnetic Resonance Imaging Score (WORMS), and suprapatellar effusion diameter. Intraclass correlation coefficients (ICC) for intra and interobserver reproducibility and Spearman correlation coefficients (r) were calculated for the parapatellar synovitis score and each scoring method. RESULTS: All of the scores presented substantial to almost perfect intrareliability. Among three readers, effusion diameter had substantial to almost perfect interreliability (ICC = 0.68-0.81) and WORMS had substantial interreliability (ICC = 0.61-0.70). For two out of three readers, there was substantial interreliability for the thickness score in T1CE (ICC = 0.55-0.69), SM scores in T1CE (ICC = 0.56-0.78) and PD-FS (ICC = 0.51-0.79), and parapatellar synovitis score in T1CE (ICC = 0.53-0.72). The parapatellar synovitis score was significantly correlated with the thickness score in T1CE (r = 0.70) and the SM score in T1CE (r = 0.81) and PD-FS (r = 0.65). CONCLUSION: The newly proposed quantitative thickness score on T1CE and the semi-quantitative SM score on T1CE and PD-FS can be useful for Hoffa's fat pad synovitis.