Gastrocnemius Recession to Treat Chronic Insertional and Noninsertional Achilles Tendinopathy

Abstract

Category: Hindfoot Introduction/Purpose: Small studies on gastrocnemius recession for Achilles tendinopathy with associated contracture of the gastrocnemius muscle are encouraging. The analyses have demonstrated fewer postoperative complications, shortened recovery time, and earlier return to work as compared to traditional surgical management of Achilles debridement and repair. Investigators have reported good patient satisfaction, substantial pain reduction, and restoration of dorsiflexion. However, there have been no large studies specifically looking at the outcomes of gastrocnemius recession for either chronic insertional or noninsertional Achilles tendinopathy. The purpose of this study was to review the efficacy of the gastrocnemius recession in mitigating pain for patients who have chronic Achilles tendinopathy with isolated gastrocnemius contracture and have failed nonoperative management. Methods: The records of patients with isolated gastrocnemius contracture were retrospectively reviewed who underwent an isolated gastrocnemius recession to treat insertional or noninsertional Achilles tendinopathy as performed by a single surgeon spanning from 2011 to 2017. Minimum follow-up time required was 6 months with an average of 25.5 months follow-up among all responders with a range from 6 to 63 months. Patients were excluded by the criteria of any other concomitant foot deformities, diagnoses, or surgical procedures performed. Clinical outcome was evaluated using a mail-in patient satisfaction questionnaire. One hundred and thirty-nine patients were identified to have underwent an isolated gastrocnemius recession to treat chronic insertional or noninsertional Achilles tendinopathy that was refractory to conservative management for a minimum of six months. Sixty-six patients (76 legs) of those eligible responded. Results: Sixty-three out of 66 patients (95.5%) were satisfied with the results of the procedure overall. Sixty-two out of 66 patients (93.9%) would elect to repeat the surgery if they knew their results in advance. Sixty-one out of 66 patients (92.4%) would recommend the surgery to a family or friend with the same diagnosis. The most frequently reported postoperative complication was 9 accounts of swelling (out of 76 legs; 11.8%). There were no reports of sural nerve injury. Responses for Visual Analogue scale (VAS) for pain were only eligible if they had reported a preoperative VAS score on their preoperative intake form. This made 23 patients eligible with an average preoperative pain of 8.43/10 and an average postoperative pain of 0.91/10. Conclusion: Gastrocnemius recession for treating chronic Achilles tendinopathy was found to be an effective procedure to mitigate pain in patients with isolated equinus contracture. To our knowledge, this is the largest study assessing gastrocnemius recession for treatment of chronic Achilles tendinopathy.