Effect of muscle atrophy and fatty infiltration on mid-term clinical, and functional outcomes after Achilles tendon repair.

OBJECTIVES: Muscle atrophy is one of the most common problems after Achilles tendon repair. The aim of this study was to evaluate the effect of gastrosoleus muscle atrophy and fatty infiltration on clinical, and functional outcomes after Achilles tendon repair. MATERIAL AND METHODS: A total of 46 patients (mean age = 39.3 ± 7.4 years) who underwent open Achilles tendon repair were included in the study. During the clinical evaluation of muscle atrophy, ipsilateral and contralateral calf circumference (CC), maximum heel rise (HR), and ankle range of motion measurements were recorded. Functional outcomes were assessed via The Achilles tendon Total Rupture Score (ATRS), the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Leppilahti score. Muscle volume (MV), cross-sectional area (CSA), and percent of fatty infiltration (FI) were measured via magnetic image resonance. RESULTS: The functional outcome scores were excellent: ATRS = 98.1 ± 2.2; AOFAS = 97.3 ± 4.1; Leppilahti score = 95.8 ± 5.1. There were significant differences detected between injured and non-injured legs regarding CC, HR, MV, CSA, and FI. Additionally, there were significant negative correlations between CSA and MV loss with all functional outcome scores. FI was correlated with only the AOFAS ankle-hindfoot score. CONCLUSIONS: Significant muscle atrophy was measured after a mean follow-up period of 7.4 (range 2.0-12.6) years post-surgery and negatively correlated with clinical outcomes. CC is an easy and cost-effective measurement method to predict MV during the follow-up of Achilles tendon repairs.

CT-guided percutaneous transpedicular biopsy for the diagnosis of vertebral lesions.

The authors report the results of a prospective study about CT-guided percutaneous transpedicular vertebral biopsy in 23 patients, 11 male and 12 female, with a mean age of 45 years (range, 17-90 years). Eleven biopsies were performed at a thoracic level, 12 at a lumbar or sacral (one) level. A diagnosis was obtained in 21 out of 23 patients (91.3%); in the remaining two cases an open biopsy was necessary, which led to the diagnosis of aneurysmal bone cyst. CT-guided percutaneous transpedicular biopsy is an effective and safe method. The transpedicular approach is especially useful for thoracic lesions, because it avoids pulmonary complications such as pneumothorax, without increasing the rate of neurologic problems. This method is not suitable for the diagnosis of aneurysmal bone cysts.