Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture

Phisitkul, Phinit; Rungprai, Chamnanni; Femino, John E.; Arunakul, Marut; Amendola, Annunziato

doi:10.1177/1071100714534215

Cited by 35 publications

(31 citation statements)

References 36 publications

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“…The efficacy and safety profile of endoscopic gastrocnemius recession (EGR) has been investigated in a number of case series with the procedure being associated with a shorter postoperative recovery, fewer wound-related complications and greater patient satisfaction[10,11]. …”

Section: Introductionmentioning

confidence: 99%

Return to physical activity after gastrocnemius recession

Ying¹,

Hong²,

Lee³

et al. 2016

WJO

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AIMTo prospectively investigate the time taken and patients’ ability to resume preoperative level of physical activity after gastrocnemius recession.METHODSEndoscopic gastrocnemius recession (EGR) was performed on 48 feet in 46 consecutive sportspersons, with a minimum follow-up of 24 mo. The Halasi Ankle Activity Score was used to quantify the level of physical activity. Time taken to return to work and physical activity was recorded. Functional outcomes were evaluated using the short form 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O and M) scores respectively. Patient’s satisfaction and pain experienced were assessed using a modified Likert scale and visual analogue scales. P-value < 0.05 was considered statistically significant.RESULTSNinety-one percent (n = 42) of all patients returned to their preoperative level of physical activity after EGR. The mean time for return to physical activity was 7.5 (2-24) mo. Ninety-eight percent (n = 45) of all patients were able to return to their preoperative employment status, with a mean time of 3.6 (1-12) mo. Ninety-six percent (n = 23) of all patients with an activity score > 2 were able to resume their preoperative level of physical activity in mean time of 8.8 mo, as compared to 86% (n = 19) of patients whose activity score was ≤ 2, with mean time of 6.1 mo. Significant improvements were noted in SF-36, AOFAS hindfoot and modified O and M scores. Ninety percent of all patients rated good or very good outcomes on the Likert scale.CONCLUSIONThe majority of patients were able to return to their pre-operative level of sporting activity after EGR.

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Section: Introductionmentioning

confidence: 99%

Return to physical activity after gastrocnemius recession

Ying¹,

Hong²,

Lee³

et al. 2016

WJO

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“…Modifications of the technique include the isolated release of the proximal tendinous portion of the medial head gastrocnemius muscle and endoscopic gastrocnemius recession 92. Due to the lack of high-level studies, there is only poor evidence in support of this treatment for patients with mid-substance tendinopathy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Achilles tendinopathy: state of the art

Ackermann

Phisitkul²,

Pearce

2018

Journal of ISAKOS

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“…Gastrocnemius recession can be performed as an open or an endoscopic procedure. The many open techniques described [ 15 – 19 ] include distal gastrocnemius recession (Strayer), proximal gastrocnemius release from the femoral condyles (Silfverskiöld), division of the gastrocnemius aponeurosis (Vulpius), and various open and percutaneous Achilles tendon lengthening procedures. Patient dissatisfaction with open procedures is generally due to poor cosmesis, neurovascular compromise, and potential wound complications.…”

Section: Discussionmentioning

confidence: 99%

“…Gastrocnemius recession can be performed as an open or an endoscopic procedure [ 15 – 19 ]. Many open techniques have been described, although poor cosmetic outcomes, neurovascular compromise, and potential wound complications can lead to patient dissatisfaction.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique

Villanueva¹,

Iborra²,

Rodríguez³

et al. 2016

BMC Musculoskelet Disord

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BackgroundIsolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure.The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra–minimally invasive gastrocnemius recession.MethodsWe performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion before and after the procedure, clinical outcomes with VAS and AOFAS scores, and potential complications, including neurovascular injuries.ResultsWe achieved complete release of the gastrocnemius tendon in all cases in the cadaveric study, with no damage to the sural nerve or vessels and minimal damage to the underlying muscle fibers. Ankle dorsiflexion increased for every patient in the study (mean, 14°; standard deviation, 3°) and was maintained throughout follow-up. The mean preoperative VAS score was 7 (6–9), which improved to 0 (0–1). The AOFAS Ankle-Hindfoot Score improved from a mean of 30 (20–40) to 93 (85–100) at 6 months. No major complications were observed. All patients returned to their previous sports after 6 months.ConclusionsAfter cadaveric and clinical study, we considered the technique to be safe and effective to perform ultrasound-guided ultra–minimally invasive gastrocnemius recession using a 1-mm incision in vivo. This novel technique represents an alternative to open techniques, with encouraging results and with the advantages of reducing pain, obviating lower limb ischemia, deeper anaesthesia, thus decreasing complications and contraindications and accelerating recovery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1265-7) contains supplementary material, which is available to authorized users.

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Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture

Abstract: Level IV, case series.

Cited by 35 publications

References 36 publications

Return to physical activity after gastrocnemius recession

Return to physical activity after gastrocnemius recession

Treatment of Achilles tendinopathy: state of the art

Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique

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