Cadaveric Study of the Junction Point Where the Gastrocnemius Aponeurosis Joins the Soleus Aponeurosis.

Tun Hing Lui,Chong Yin Mak

doi:10.2174/1874325001711010762

Abstract

Purpose:To study the location of the junction point where the gastrocnemius aponeurosis joins the soleus aponeurosis to form the Achilles tendon.Methods:Twelve lower limb specimens were used. The distance between the medial tibial plateau and the superior border of the posterior calcaneal tubercle (A) was measured and the distances of the junction point to the superior border of the posterior calcaneal tubercle (B) were measured.Result:The ratio B/A averaged 0.45. The gastrocnemius muscle reached or extended beyond the junction point in eight specimens (67%). The average distance from the lowest border of the muscle to the junction point was 0±12mm (-25-25).Conclusion:There are great anatomical variations of the gastrocnemius insertion. Resection of muscle bound portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.Clinical Relevance:This report suggests that resection of muscle bound portion rather than the muscle void portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.

Highlights

A gastrocnemius equinus is typically characterized by less than 10° of ankle dorsiflexion with the knee extended with positive Silfverskiold test [1]
As a minimally invasive approach, the portal wounds are small and it should be accurately placed at the level of the muscle void portion of the gastrocnemius aponeurosis
We believe that the junction point where the gastrocnemius aponeurosis joins the soleus aponeurosis to form the Achilles tendon is an important landmark

Summary

Introduction

A gastrocnemius equinus is typically characterized by less than 10° of ankle dorsiflexion with the knee extended with positive Silfverskiold test [1] This can lead to various secondary problems, including Achilles tendinosis, flatfoot, lower back pain or strain, knee hyperextension (genu recurvatum), plantar fasciitis, midfoot pain or arthritis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers [2 - 5]. Endoscopic gastrocnemius recessions have been developed recently and reported to have fewer complications and better cosmetic outcome [2, 3, 16 - 26]. They have been used as an adjunctive treatment of posterior tibial tendon dysfunction, forefoot nerve entrapment, metatarsalgia, refractory Achilles tendinopathy, cerebral palsy and pediatric pes planovalgus [16, 18 - 20, 27 - 29]. We hypothesized that the junction point can be accurately determined by studying the relationship of the point with the other surface landmarks

Methods

Results

Discussion

Conclusion