ABSTRACT
The Achilles tendon is the largest, and most commonly torn tendon in the body. The Achilles is usually torn at a region of relative hypo-vascularity proximal to its insertion. However, partial thickness tears and other pathologies often occur at its insertion on the calcaneus. Anatomically, the insertion is a confluence of the gastrocnemius and soleus muscles that fuse to form a myotendinous unit on the posterosuperior aspect of the calcaneus. This review aims to reveal the insertional footprint as individual fascicular components attaching to facets of calcaneal tuberosity. Understanding this anatomy is essential for interpreting tear patterns and surgical implications.
ABSTRACT
BACKGROUND: Frailty is rampant in candidates of liver transplantation (LT); however, its impact on posttransplant survival is inconclusive. Most studies have used a single measure of frailty; however, a comprehensive frailty severity index (FSI) has not been developed. The objectives of this study were to (1) evaluate frailty utilizing several metrics, (2) develop an FSI for end-stage liver disease (ESLD), and (3) determine its predictive abilities for outcomes after LT. METHODS: Frailty metrics included (1) modified nutrition assessment of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition that includes height-adjusted third lumbar vertebra psoas mass index, (2) physical performance assessment combining Karnofsky Performance Status and pressure injury scale, and (3) Controlling Nutritional Status as a measure of severity of liver disease and inflammation. RESULTS: Moderate to severe frailty was reported in 52%-97% of recipients depending on the metric. A statistically significant threshold FSI value was identified for each adverse outcome studied. FSI ≥ 14 was associated with decreased survival (88% vs 97% for FSI < 14). CONCLUSIONS: The proposed FSI for ESLD is predictive of poorer outcomes after LT.
