The conjoint junction of the triceps surae: Implications for gastrocnemius tendon lengthening

Elson, David W.; Whiten, S; Hillman, Susan J.; Johnson, Roger; Lo, Siu-Fai; Robb, James

doi:10.1002/ca.20544

Cited by 17 publications

(21 citation statements)

References 9 publications

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“…The variations in the anatomy of the conjoint junction of the triceps surae and the implications for surgical lengthening have recently been reported. 3 In Zone-1 it is possible to lengthen the gastrocnemius in isolation or to lengthen the gastrocnemius and the soleus in a differential fashion. 4,5 In Zone-2, the amount of lengthening achieved by division of the conjoined tendon in the inverted V-shape, 6 or the tongue-ingroove manner is similar.…”

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confidence: 99%

Gastrocsoleus recession techniques

Tinney

Khot

Eizenberg

et al. 2014

The Bone & Joint Journal

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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).

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confidence: 99%

Gastrocsoleus recession techniques

Tinney

Khot

Eizenberg

et al. 2014

The Bone & Joint Journal

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“…We confirmed the findings of Elson et al. (2007) and Blitz and Eliot (2007, 2008) that the conjoint junction varies widely in length and configuration. In most cases, the level of the fusion of the conjoint junction is proximal to the muscular-tendinous junction at the lateral side, which can make it difficult to find the plane between soleus and gastrocnemius and to perform the recession at the MFRL.…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with our data (direct attachment in one-third of the specimens), Blitz and Eliot (2007, 2008) reported a direct attachment of the gastrocnemius aponeurosis to the soleus fascia in one-third of specimens, and Elson et al. (2007) reported a direct attachment in half and an asymmetry in the conjoint junction in one-third. This contrasts with the results of Hansen (2000), who reported that the gastrocnemius and soleus coalesced at the distal end.…”

Section: Discussionmentioning

confidence: 99%

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Gastrocnemius recession: A cadaveric study of surgical safety and effectiveness

2017

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Background and purposeMany methods of gastrocnemius lengthening have been described, with different surgical challenges, outcomes, and risks to the sural nerve. Our aims were (1) to locate the gastrocnemius muscular-tendinous junction in relation to the mid-length of the fibula (from here on designated the mid-fibula), (2) to compare the dorsiflexion achieved with dorsal recession or ventral recession, and (3) to determine the risk of injury to the sural nerve during gastrocnemius recession.MethodsIn 10 pairs of fresh-frozen adult cadaveric lower extremities transected above the knee, we measured dorsiflexion, performed dorsal or ventral gastrocnemius recession at the mid-fibula, and then measured the increase in dorsiflexion and fasciotomy gap. We noted the course of the sural nerve and whether the gastrocnemius muscle provided it with enough muscular coverage to protect it during recession.ResultsDorsal and ventral recession produced statistically (p < 0.05) and clinically significant mean increases in dorsiflexion with extended knee from 12° to 19°, but they were not statistically significantly different from each other in this measure or in fasciotomy gap size. At the mid-fibula, the sural nerve coursed superficially between both heads of the gastrocnemius muscle in 14 of 20 specimens. Sufficient gastrocnemius muscle coverage to protect the sural nerve was provided by the medial head in 18 of 20 specimens and by the lateral head in only 5 of 20 specimens.InterpretationA ventral gastrocnemius recession proximal to the mid-fibula level poses less risk to the sural nerve than a recession at the mid-fibula. This procedure provides adequate lengthening (1–3 cm) and increased dorsiflexion (compared with baseline), with less risk to the sural nerve than is incurred with recession at the mid-fibular reference line.

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Anatomical study of the soleus: Application to improved imaging diagnoses

et al. 2020

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Introduction Strains of the soleus are widely found both in amateur and professional athletes. For their accurate regional diagnoses, understanding the anatomy of the spatial relationship between muscular fibers and tendinous structures is important because their interfaces are susceptible sites to muscle strains. Therefore, this study evaluated the precise architecture of the soleus. Materials and Methods We evaluated the precise anatomical architecture of the soleus in 87 formaldehyde‐fixed soleus muscles. To calculate mean relative physiological cross‐sectional area of each muscular fiber compartment, we measured the fiber length, volume, and pennation angle in isolated compartments. Results The posterior soleus surface was covered by a broad aponeurotic posterior insertion tendon (PIT), which continued inferiorly to the insertion tendon. The anterior surface had three aponeurotic origin tendons, lateral origin tendon (LOT), medial origin tendon (MOT), and tendinous arch, which were arranged along the soleus margins. The anterior bipennate muscle portion (ABP), surrounded by the three origin structures, terminated as the sagittal insertion tendon (SIT), which continued inferiorly to PIT. The posterior main muscle portion behind LOT and MOT was separated into lateral and medial portions by the SIT. The soleus thus possessed a broad musculotendinous junction. Furthermore, ABP exhibited wide structural diversity in shape and size: in extreme cases, it was duplicated or absent. Conclusion Systematic anatomical descriptions of the soleus will be useful for accurate regional diagnosis of its strains with magnetic resonance imaging and ultrasonography.

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The conjoint junction of the triceps surae: Implications for gastrocnemius tendon lengthening

Cited by 17 publications

References 9 publications

Gastrocsoleus recession techniques

Gastrocsoleus recession techniques

Gastrocnemius recession: A cadaveric study of surgical safety and effectiveness

Anatomical study of the soleus: Application to improved imaging diagnoses

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