Gastrocsoleus recession techniques

Abstract

Lengthening of the conjoined tendon of the gastrocnemius aponeurosis and soleus fascia is frequently used in the treatment of equinus deformities in children and adults. The Vulpius procedure as described in most orthopaedic texts is a division of the conjoined tendon in the shape of an inverted V. However, transverse division was also described by Vulpius and Stoffel, and has been reported in some clinical studies. We studied the anatomy and biomechanics of transverse division of the conjoined tendon in 12 human cadavers (24 legs). Transverse division of the conjoined tendon resulted in predictable, controlled lengthening of the gastrocsoleus muscle-tendon unit. The lengthening achieved was dependent both on the level of the cut in the conjoined tendon and division of the midline raphé. Division at a proximal level resulted in a mean lengthening of 15.2 mm (sd 2.0, (12 to 19), which increased to 17.1 mm (sd 1.8, (14 to 20) after division of the midline raphé. Division at a distal level resulted in a mean lengthening of 21.0 mm (sd 2.0, (18 to 25), which increased to 26.4 mm (sd 1.4, (24 to 29) after division of the raphé. These differences were significant (p < 0.001).

Comparison of the efficacy of three isolated gastrocnemius recession procedures in a cadaveric model of gastrocnemius tightness

“…In previous studies, formaldehyde-preserved specimens were usually used to compare different techniques for lengthening the gastrocnemius-soleus complex [14,16]. The equinus deformity is induced by gravity and the postmortem shortening of soft tissue after formaldehyde preservation [14].…”

“…After the gastrocnemius recession procedures, as described in previous studies [14,16], a progressive dorsiflexion force was applied to the metatarsal heads with the knee extended. Because the formaldehyde preservation can lead to approximately five-fold increase in muscle stiffness, the dorsiflexion force on our fresh cadavers was increased from 4 to 10 kg, using an increment of 2 kg, which is one fifth of the forces used with formaldehyde-preserved specimens [14,16].…”

“…Because the formaldehyde preservation can lead to approximately five-fold increase in muscle stiffness, the dorsiflexion force on our fresh cadavers was increased from 4 to 10 kg, using an increment of 2 kg, which is one fifth of the forces used with formaldehyde-preserved specimens [14,16]. At each level of the applied dorsiflexion force, the distance between the ends of the incised aponeurosis was measured with a vernier caliper.…”

Gastrocnemius recession: A cadaveric study of surgical safety and effectiveness

“…Our data for the gap size are consistent with those of Tinney et al. (2014), who used formaldehyde-preserved human cadavers. Formaldehyde increases tendon stiffness because of increased crosslinking of collagen and other proteins (Wilke et al.…”

“…2013, Tinney et al. 2014). Several approaches to reducing a gastroc-soleus equinus involve a fasciotomy or tenotomy of the gastrocnemius or triceps surae tendon that is either dorsal or ventral and at either proximal or distal level in the triceps surae or gastrocnemius tendon (Vulpius and Stoffel 1913, Silfverskiöld 1923, Hoke 1931, White 1943, Strayer 1950, Baker 1956, Hansen 2000, Saraph et al.…”