Keywords:
Musculoskeletal system, Musculoskeletal soft tissue, Extremities, MR, Surgery, Diagnostic procedure, Trauma
Authors:
A. Gedminaite, V. Augustinavicius, A. Brazaitis, A. Makulavicius, N. Porvaneckas, M. Urmanavicius; Vilnius/LT
DOI:
10.1594/essr2018/P-0046
Methods and Materials
A randomised study was carried out with 57 patients (mean age years SD; 7 (12,28 %) females,
50 (87,72 %) males),
who have suffered a traumatic rupture in the distal or middle third of the Achilles tendon (29 (50,88 %) right,
28 (49.12 %) left).
Inclusion criteria were an acute (less than two weeks) closed rupture in the distal or middle third of the of Achilles tendon,
patient’s age between 18 to 65 years and the patient’s motivation and agreement to participate.
The patients were distributed according to the operative method used (Group 1 - open surgery (OS) n=26 (47%) or Group 2 - percutaneous surgery (PS) n= 31 (53%)).
Fig.
1 and 2.
Postoperative rehabilitation was the same for both groups.
Calf-ankle MRI examinations were performed 6 months after surgery.
13 patients had a follow up MRI 24 months after surgery.
MRI examinations were performed with Siemens AG Symphony Tim 1.5 T scanner.
The standard protocol was used,
including axial T1,
isotropic T2,
axial and isotropic Proton Density (PD) with Fat Suppression (FS) sequences.
Measurements were taken using a Siemens Syngo.via workstation.
Differences of the parameters in the healthy and the injured legs were compared between operative groups.
On the initial and follow up MRI examinations these measurements were taken and parameters evaluated:
-
The length of the Achilles tendon (measuring from the myotendinous junction to calcaneal insertion on sagittal reconstructions) Fig.3.
-
The cross-sectional area of the Achilles tendon (measured 5 centimeters above its insertion on axial images)
-
The cross-sectional area of the calf and its posterior group muscles (medial head of gastrocnemius (MGM),
lateral head of gastrocnemius (LGM),
soleus (MS),
flexor digitorum longus (FDL),
tibialis posterior (TP) and flexor hallucis longus (FHL) muscles) (measured at the widest calf/muscle belly part on axial images) Fig.4.
-
Muscle atrophy (evaluated according to the Goutallier classification (grade 0 - normal muscle,
grade 1 - some fatty streaks,
grade 2 - less than 50% fatty muscle atrophy,
grade 3 - 50% fatty muscle atrophy,
grade 4 - greater than 50% fatty muscle atrophy)) [8] Fig.5
-
Changes in structure of the Achilles tendon (mucoid degeneration and intratendinous cyst formation) [9]
Statistical analysis was performed using IBM SPSS Statistics (V23).
The result was considered statistically significant if the p-value was lower than 0.05.