Gastrocnemius Recession for Chronic Noninsertional Achilles Tendinopathy

Kiewiet, Nathan J.; Holthusen, Scott M.; Bohay, Donald R.; Anderson, John G.

doi:10.1177/1071100713477620

Cited by 58 publications

(32 citation statements)

References 36 publications

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“…Gastrocnemius recession is one of several surgical procedures for non-insertional Achilles tendinopathy, plantar fasciitis, and associated problems; however, the best option remains controversial [ 11 , 12 , 23 – 30 ]. All these procedures can be performed under ultrasound guidance in an ultra–minimally invasive way [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…The resulting equinus deformity alters foot biomechanics and increases forefoot pressure, aggravating or predisposing to conditions such as Achilles tendinosis, flatfoot, lower back pain or strain, diabetic foot ulcer, knee hyperextension (genu recurvatum), metatarsalgia, plantar fasciitis, midfoot pain or arthritis, lateral foot pain, and nerve entrapment. In children, the deformity has been associated with equinus foot, spasticity, and cerebral palsy [ 1 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Villanueva¹,

Iborra²,

Rodríguez³

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Operative methods were demonstrated to improve tendinopathy patient's conditions, though success rates varied between operative techniques (Alfredson et al 2013;Benazzo et al 2013;Greenhagen et al 2013;Kiewiet et al 2013;Koh et al 2013;Maier et al 2013;Maquirriain 2013;Schon et al 2013) and between subjects according to sex and activity level (David et al 2013). The outcomes are probably affected by the tendon healing responses after surgical excision of pathological tissues.…”

Section: Tendinopathies: Current Treatmentsmentioning

confidence: 95%

Functional Tissue Engineering for Tendinopathies: What’s New on the Horizon?

Chan¹,

Fu²,

Yung³

2015

Sports Injuries

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“…[11][12][13][14][15] When nonoperative care is unsuccessful and the patient presents with an isolated gastrocnemius contracture, the gastrocnemius recession procedure is an increasingly utilized operative approach for recalcitrant AT. 9,[16][17][18][19][20][21][22][23] The gastrocnemius recession aims to unload the Achilles tendon in order to relieve pain, restore ankle dorsiflexion, and improve patient function. 1,2,23,24 More specifically, the Strayer approach of the gastrocnemius recession selectively lengthens the gastrocnemius portion of the posterior compartment with the intent to preserve as much functional strength as possible.…”

Section: Introductionmentioning

confidence: 99%

Changes in Muscle Morphology Following Gastrocnemius Recession for Achilles Tendinopathy: A Prospective Cohort Imaging Study

DiLiberto

Nawoczenski

Tome

et al. 2019

Foot & Ankle Specialist

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Background. The purpose of this study was to evaluate changes in posterior compartment muscle volume and intramuscular fat content following gastrocnemius recession in people with Achilles tendinopathy (AT). Methods. Eight patients diagnosed with unilateral recalcitrant AT and an isolated gastrocnemius contracture participated in this prospective cohort study. Magnetic resonance imaging was performed on both limbs of each participant before and 6 months following an isolated gastrocnemius recession. Involved limb muscle volumes and fat fractions (FFs) of the medial gastrocnemius, lateral gastrocnemius, and soleus muscle were normalized to the uninvolved limb. Preoperative to postoperative comparisons were made with Wilcoxon signed-rank tests. Results. Soleus or lateral gastrocnemius muscle volumes or FFs were not significantly different between study time points. A significant difference was found in medial gastrocnemius muscle volume (decrease; P = .012) and FF (increase; P = .017). Conclusion. A major goal of the Strayer gastrocnemius recession, selective lengthening of the posterior compartment while preserving soleus muscle morphology, was supported. The observed changes isolated to the medial gastrocnemius muscle may reduce ankle plantarflexion torque capacity. Study findings may help inform selection of surgical candidates, refine anticipated outcomes, and better direct postoperative rehabilitation following gastrocnemius recession for AT. Levels of Evidence: Level IV: Prospective cohort study

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Gastrocnemius Recession for Chronic Noninsertional Achilles Tendinopathy

Abstract: Gastrocnemius recession for the treatment of refractory Achilles tendinopathy was a viable treatment option following the failure of nonoperative management. All 8 of our patients had excellent pain relief, good clinical outcome, and were satisfied at the time of follow-up.

Cited by 58 publications

References 36 publications

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

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

Functional Tissue Engineering for Tendinopathies: What’s New on the Horizon?

Changes in Muscle Morphology Following Gastrocnemius Recession for Achilles Tendinopathy: A Prospective Cohort Imaging Study

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