Gastrocnemius Recession Research Articles

Effects of gastrocnemius recession on ankle motion, strength, and functional outcomes: a systematic review and national healthcare database analysis.

The purpose of this systematic review was to report the effects of gastrocnemius recession on ankle dorsiflexion range of motion, function, and push-off power. The MEDLINE and EMBASE databases were reviewed with terms "gastrocnemius recession". The inclusion criteria were: (1) clinical studies, (2) published in a peer-reviewed journal within the past 10 years, and (3) published in English. Excluded were: (1) review articles, (2) cadaveric studies, (3) studies including patients under the age of 18 years, (4) studies evaluating a neurologic condition, (5) level of evidence 5, and (6) Quality of Evidence Score <3. Data were then extracted and analysed for trends. The PearlDiver Database was also used to review de-identified patient information retrospectively between 2007 and 2011. Full-text review yielded 23 articles that fit the inclusion criteria. Twenty-one of 23 (91%) and 2/23 (9%) studies were level of evidence 4 and 3, respectively. Twelve of 23 (52%) studies reported follow-up assessment between 12 and 36 months, and no studies reported longer-term follow-up. Twelve of 12 (100%) studies reported improved dorsiflexion range of motion 9/9 (100%) reported improved AOFAS, and 11/11 (100%) reported improved VAS. Five of 23 (22%) studies reported strength in a measured and controlled fashion with variable results, but of these, no study reported a return to normal power. The mean complication rate was 14%. The available evidence supports that GR improves functional outcomes and increases dorsiflexion range of motion. Furthermore, GR affects gait kinematics, which may cause compensatory effects at the knee, ankle, and subtalar joints. Evidence has shown that power does not return to normal levels. Clinicians may utilize these data clinically to determine whether patients may benefit from GR or not. IV.

Endoscopic Gastrocnemius Intramuscular Aponeurotic Recession

Gastrocnemius aponeurotic recession is the surgical treatment for symptomatic gastrocnemius contracture. Endoscopic gastrocnemius recession procedures has been developed recently and reported to have fewer complications and better cosmetic outcomes. Classically, this is performed at the aponeurosis distal to the gastrocnemius muscle attachment. We describe an alternative endoscopic approach in which the intramuscular portion of the aponeurosis is released.

Gastrocnemius recession compared to tendo‐achilles lengthening for surgical correction of equinus deformity in children with cerebral palsy: are we under or over correcting based on gait analysis?

Gastrocnemius recession compared to tendo‐achilles lengthening for surgical correction of equinus deformity in children with cerebral palsy: are we under or over correcting based on gait analysis?

Contribution of Lateral Column Lengthening to Correction of Forefoot Abduction in Stage IIb Adult Acquired Flatfoot Deformity Reconstruction.

Correction of forefoot abduction in stage IIb adult acquired flatfoot likely depends on the amount of lateral column lengthening (LCL) performed, although this represents only one aspect of a successful reconstruction. The purpose of this study was to evaluate the correlation between common reconstructive variables and the observed change in forefoot abduction. Forty-one patients who underwent flatfoot reconstruction involving an Evans-type LCL were assessed retrospectively. Preoperative and postoperative anteroposterior (AP) radiographs of the foot at a minimum of 40 weeks (mean, 2 years) after surgery were reviewed to determine correction in forefoot abduction as measured by talonavicular coverage (TNC) angle, talonavicular uncoverage percent, talus-first metatarsal (T-1MT) angle, and lateral incongruency angle. Fourteen demographic and intraoperative variables were evaluated for association with change in forefoot abduction including age, gender, height, weight, body mass index, as well as the amount of LCL and medializing calcaneal osteotomy performed, LCL graft type, Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament repair, gastrocnemius recession and any one of the modified McBride/Akin/Silver procedures. Two variables significantly affected the change in lateral incongruency angle. These were weight (P = .04) and the amount of LCL performed (P < .001). No variables were associated with the change in TNC angle, talonavicular uncoverage percent, or T-1MT angle. Multivariate regression analysis revealed that LCL was the only significant predictor of the change in lateral incongruency angle. The final regression model for LCL showed a good fit (R2 = 0.70, P < .001). Each millimeter of LCL corresponded to a 6.8-degree change in lateral incongruency angle. Correction of forefoot abduction in flatfoot reconstruction was primarily determined by the LCL procedure and could be modeled linearly. We believe that the lateral incongruency angle can serve as a valuable preoperative measurement to help surgeons titrate the proper amount of correction performed intraoperatively.

Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients.

Gastrocnemius recession has become a popular procedure to treat the equinus ankle caused by a tight gastrocnemius. The aim of our study was to prospectively evaluate the safety and efficacy of the endoscopic gastrocnemius recession procedure using a single portal technique. The endoscopic gastrocnemius recession procedure was performed on 56 feet in 54 consecutive patients through a single lateral portal using the Smart Release Endoscopic Carpal Tunnel Release System. The minimum follow-up was 12 months. Functional outcomes were assessed with the Short Form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O&M) score. A modified Likert scale and visual analogue scores (VAS) were used to evaluate patient satisfaction and pain scores, respectively. Postoperative morbidities were documented for wound complications, scar hypersensitivity, sural nerve deficit and plantar flexion weakness. A p-value <0.05 was considered statistically significant. Endoscopic gastrocnemius recession procedure performed through a single lateral portal was successfully performed in all cases. Seven out of the eight component scores of the SF-36 questionnaire showed significant improvements. The AOFAS Hindfoot score showed a significant improvement of 20.69 ± 19.20. The modified O&M score also revealed significant improvements in eight out of nine component scores. There was a significant improvement of 3.79 ± 2.49 in VAS scores. A total of 91.07 % of all cases reported good or very good outcomes on the Likert scale. Eleven complications were recorded (three cases of unsatisfactory operative scar, three cases of sural nerve dysesthesia and five cases of subjective plantar flexion weakness with complete resolution in two out of the five patients.). This study demonstrates that the endoscopic gastrocnemius recession procedure performed through a single portal technique has low morbidity with good to excellent results. Level III, retrospective study.

Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations

Gastrocnemius recession is a surgical technique commonly performed on individuals who suffer from symptoms related to the restricted ankle dorsiflexion that results when tight superficial posterior compartment musculature causes an equinus contracture. Numerous variations for muscle-tendon unit release along the length of the calf have been described for this procedure over the past century, although all techniques share at least partial or complete release of the gastrocnemius muscle given its role as the primary plantarflexor of the ankle. There exists strong evidence to support the use of this procedure in pediatric patients suffering from cerebral palsy, and increasingly enthusiastic support-but less science-behind its application in treating adult foot and ankle pathologies perceived to be associated with gastrocnemius tightness. The purpose of this study, therefore, was to evaluate currently available evidence for using gastrocnemius recession in three adult populations for whom it is now commonly employed: Achilles tendinopathy, midfoot-forefoot overload syndrome, and diabetic foot ulcers. A systematic review of the literature was performed on December 21, 2013 using the PubMed, Scopus, and Cochrane databases along with the search term "(gastrocnemius OR gastrocsoleus) AND (recession OR release OR lengthening)." This search generated 1141 results; 12 articles found in the references of these papers were also screened for inclusion. In total, 18 articles met our inclusion criteria. These articles were reviewed and assigned a classification (I-V) of Level of Evidence, according to the criteria recommended by the Journal of Bone & Joint Surgery. Based on these classifications, a Grade of Recommendation was assigned for each of the indications of interest. Grade B evidence-based literature ("fair") exists to support the use of gastrocnemius recession for the treatment of isolated foot pain due to midfoot/forefoot overload syndrome in adults. There are some data in support of utilizing gastrocnemius recession to treat midfoot or forefoot ulcers and non-insertional Achilles tendinopathy in adults, but to date this evidence remains Grade Cf. Insufficient evidence (Grade I) is currently available to make any recommendation either for or against this procedure for the treatment of insertional Achilles tendinopathy. Scientific literature continues to grow in support of using isolated gastrocnemius recession as an effective treatment strategy for a variety of lower limb pathologies, although it remains clear that higher evidence levels and more carefully controlled investigations will be necessary to more convincingly define the true efficacy and ideal applications of gastrocnemius recession in the adult population. Level IV systematic review.

Gastrocnemius recession: a Panacea for What Ails the foot and ankle: commentary on an article by Deborah A. Nawoczenski, PT, PhD, et al.: "isolated gastrocnemius recession for achilles tendinopathy: strength and functional outcomes".

Commentary In recent years, there seems to be a trend toward performing large numbers of gastrocnemius recessions for a variety of pathological conditions of the foot and ankle. Whether it be as part of a complex flat or cavus foot reconstruction or to improve dorsiflexion, to offload forefoot pressures when treating diabetic ulcers, or, in the case of this paper, to decrease tension across the Achilles to treat tendinopathy, there is no doubt that the gastrocnemius recession has emerged as a vital tool in the armamentarium of the foot and ankle surgeon. While there are several case series that demonstrate promising results with regard to pain relief after gastrocnemius recession for Achilles tendinopathy1,2, the literature has not been as defined regarding the effect on plantar-flexion strength postoperatively3,4. Some of these limitations include small sample size, retrospective study designs with no preoperative strength-testing for comparison, and gastrocnemius recession procedures performed in conjunction with other major reconstructive procedures, making it difficult to determine what effect the recession would have in isolation. The present study does an admirable job of quantifying the pain relief, strength, and function following a gastrocnemius recession. The results are very encouraging with regard to reducing pain and improving patient-reported satisfaction. The results of strength-testing and self-reported sports function may be a little less promising; however, this comes as no surprise. We believe that this procedure is so effective because by lengthening the gastrocnemius, the muscle is weakened. In the case of tendinopathy, this muscle-weakening reduces the stress across the degenerative portion of the tendon, and with other pathological processes, it reduces the deforming force of the gastrocnemius-soleus complex. The decrease in calf circumference postoperatively seems to support this assumption. The authors also addressed the small sample size, but they did not separate the cases with insertional and midsubstance disease. We believe that it may be beneficial to look at these entities separately, as they are distinct clinical problems that may respond differently to an isolated recession. This current study certainly supports the use of gastrocnemius recession to relieve pain associated with Achilles tendinopathy. However, patients should be counseled that they might still have difficulty with high-impact and sporting activities postoperatively. These authors should be commended for this analysis of outcomes following a gastrocnemius recession for the treatment of Achilles tendinopathy, yet we should exercise some caution when interpreting their results. As they point out in the discussion section, it is difficult to interpret the strength data, as they did not have preoperative isokinetic strength measures, and it is possible that the patients with tendinopathy were stronger than the patients in the control group preoperatively. As the clinical indications for performing gastrocnemius recession continue to expand, it will be important to continue to look critically at the subjective and objective outcome data. Myotendinous recession has been used successfully to treat spasticity and contractures in the pediatric population as well as to increase motion by reducing the contractile force of the spastic muscle. We feel that the gastrocnemius recession is no different. Perhaps the perceived improvement in strength may come from removing both the pain and the inhibition that it causes by correcting the underlying pathological process, whether it be a painful foot deformity, ankle arthritis, or, in this study, tendinopathy. Nonetheless, gastrocnemius recession is here to stay, and we will continue to incorporate this procedure into our clinical practice, relying on its ability to weaken the gastrocnemius muscle to achieve the desired clinical result.

Isolated Gastrocnemius Recession for Achilles Tendinopathy: Strength and Functional Outcomes

Gastrocnemius recession has emerged as a viable intervention for patients with recalcitrant foot and ankle disorders associated with isolated gastrocnemius contracture. The purpose of this case-control study was to investigate the effects of an isolated gastrocnemius recession on pain, patient-reported function, and strength in patients with chronic Achilles tendinopathy and an isolated gastrocnemius contracture. Thirteen patients with unilateral Achilles tendinopathy (mean age [and standard deviation], fifty-two ± 7.7 years) who received a gastrocnemius recession and ten matched-control subjects participated. A visual analog scale was used to assess pain, and the Foot and Ankle Ability Measure was used to evaluate patient-reported function in activities of daily living and sports. Patients were asked about their satisfaction with the results of the gastrocnemius recession. Ankle plantar flexion peak torque was assessed at 60°/sec and 120°/sec. Appropriate t tests were used to assess limb symmetry and strength differences between the groups. The mean duration of follow-up was eighteen months (range, twelve to twenty-eight months). Gastrocnemius recession provided significant pain relief (mean preoperative visual analog scale score [and standard deviation], 6.8 ± 1.8; mean follow-up visual analog scale score, 1.4 ± 2.7; p < 0.05). Foot and Ankle Ability Measure outcomes showed between-group differences in activities of daily living (Achilles tendinopathy group, 89.7; control group, 98.5; p = 0.05) and sports subscales (Achilles tendinopathy group, 71.9; control group, 95.1; p = 0.05). The activities reported to be the most challenging included going up hills, climbing stairs, running, and jumping. Eleven of the thirteen patients in the Achilles tendon group were satisfied with treatment. Side-to-side strength comparisons showed no differences at 60°/sec. Significant differences were observed at 120°/sec (Achilles tendinopathy group, 21%; control group, 3%; p < 0.05); however, the involved limb reached a peak torque similar to that in the control limb. Isolated gastrocnemius recession provides significant and sustained pain relief for chronic Achilles tendinopathy. Good function can be expected for activities of daily living, but power and endurance activities were more problematic for the Achilles tendinopathy group. Isokinetic strength assessment may not effectively capture patient-reported functional deficits. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tendon lengthening and fascia release for healing and preventing diabetic foot ulcers: a systematic review and meta-analysis.

BackgroundDiabetic foot ulcers have a devastating impact on an individual’s health-related quality of life and functional status. Additionally, diabetic foot ulcers impose a significant economic burden on our health care systems as a result of complications such as infection, hospitalisation and amputation. The current gold standard treatment for diabetic foot ulcers is total contact casting. However, the rate of ulcer recurrence is high, indicating the need for more effective long-term treatment options. Therefore, the aim of this study was to systematically identify, critique and evaluate all literature investigating the effectiveness of Achilles tendon lengthening, gastrocnemius recession and selective plantar fascia release in healing and preventing diabetic foot ulcers.ReviewSearches were conducted in MEDLINE, CINAHL, AMED, EMBASE and The Cochrane Library from the earliest available date to November 2014. Methodological quality of included studies was assessed using the Downs and Black checklist. Data from randomised-controlled trials were analysed using random effects meta-analysis. For all other studies, data were analysed descriptively.Eleven studies (614 participants) were included in the review, with a median sample size of 29 participants. Meta-analysis of two randomised-controlled trials found that there was no statistically significant difference between Achilles tendon lengthening or gastrocnemius recession and total contact casting for time to healing of diabetic foot ulcers (mean difference, MD, 8.22 days; 95 % CI, −18.99 to 35.43; P = 0.55; I2 = 34 %) and the rate of ulcers healed (risk ratio, RR, 1.06; 95 % CI, 0.94 to 1.20; P = 0.34; I2 = 41 %). The rate of ulcer recurrence was significantly lower following Achilles tendon lengthening or gastrocnemius recession than total contact casting (RR, 0.45; 95 % CI, 0.28 to 0.72; P < 0.001; I2 = 0 %).ConclusionsAchilles tendon lengthening and gastrocnemius recession appear to be effective surgical treatments for healing diabetic foot ulcers. The rate of ulcer recurrence was lower following Achilles tendon lengthening or gastrocnemius recession procedures compared to total contact casting treatment alone. Therefore, these surgical procedures may provide viable treatment options for the management and prevention of diabetic foot ulcers. Further rigorous randomised-controlled trials with longer follow-up are required to determine the long-term effectiveness and safety of these procedures.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0085-6) contains supplementary material, which is available to authorized users.

Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy: A Pilot Study.

Many surgeries exist for treatment of insertional Achilles tendinopathy. Another surgical option to consider is an isolated gastrocnemius recession. Recent studies have demonstrated the success of a gastrocnemius recession for noninsertional Achilles tendinitis. We hypothesize that an isolated gastrocnemius recession can be a successful, effective, and less invasive surgery for patients with chronic insertional Achilles tendinopathy. This article presents a retrospective review of one surgeon's results of 11 patients (2010-2012), with an average age of 59 years who presented with chronic insertional Achilles tendinopathy. Gastrocnemius recessions, either endoscopic or open, were performed after an average of 6.2 months of conservative treatment. All patients' radiographs were reviewed preoperatively for any calcaneal spurs and divided into groups accordingly. Average follow-up time postoperatively was 13.8 months. Plantarflexion strength, equinus deformity, as well as the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instrument was assessed. In all, 10/11 (91%) patients had high patient satisfaction, pain relief, no residual equinus deformity, loss in muscle strength and returned to regular activities successfully at 1-year follow up. All patients and groups had significant improvement in AOFAS scores. The median postoperative AOFAS score was 94.8. All patients and patient groups had significant improvement pre- to postoperatively. Patients without spurs appear to do better than patients with spurs. One patient developed recurrence of insertional heel pain and equinus deformity. Other complications included 2 sural nerve parasthesias, which resolved. An isolated gastrocnemius recession for chronic insertional Achilles tendinopathy can provide high satisfaction, pain relief, and a faster recovery period with few or no complications. Therapeutic, Level IV: Case series.

Results after gastrocnemius recession in 73 patients.

Very few studies describe the clinical results and complications following the surgical procedure of gastrocnemius recession. To survey the patient reported outcomes in patients operated with gastrocnemius recession as single procedure for various foot conditions. 93 patients operated with gastrocnemius recession as single procedure between 2006 and 2011 were detected in the database. 73 patients responded to the invitation for study participation. Questionnaires containing patient reported satisfaction, complications, plantar flexion power and visual analog pain score were used for evaluation of the postoperative result. 45/73 (62%) patients reported a good or excellent result. 8/73 (11%) patients reported a significant postoperative complication. 16/73 (22%) patients noted reduced or severely reduced plantar flexion power after surgery. VAS pain score significantly decreased from 7.0 before surgery to 1.8 (p=0.015) after surgery for patients with plantar fasciitis (n=18) and from 5.6 to 2.3 (p<0.01) for patients with metatarsalgia (n=28). Patients treated with gastrocnemius recession for plantar fasciitis demonstrated good clinical results. The complication rate was higher than reported by others.

Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture: A Prospective Study on 320 Consecutive Patients.

Endoscopic gastrocnemius recession has been proposed as a minimally invasive technique for the treatment of isolated gastrocnemius contracture. We report on the safety and efficacy of endoscopic gastrocnemius recession, as an isolated procedure or combined with other concomitant procedures in terms of improvement in ankle dorsiflexion, functional outcome, and postoperative morbidities. The data were prospectively collected in this case series. Endoscopic gastrocnemius recession was performed by a single surgeon in 320 consecutive patients (344 feet) who were diagnosed with isolated gastrocnemius contracture and failed nonoperative treatments between March 2009 and December 2012. There were 180 women and 140 men with mean age, 47.1 ± 15.7 years. The minimum follow-up was 1 year (mean, 18 months; range, 12 to 53 months). Pre- and postoperative ankle dorsiflexion, pain (Visual Analog Scale [VAS]), SF-36, and Foot Function Index (FFI) were obtained and compared using paired sample t test and Wilcoxon signed-rank test. The mean ankle dorsiflexion significantly improved from -0.8 ± 5.4 degrees preoperatively to 11.0 ± 6.6 degrees at average of 13 months postoperatively (n = 294) (P < .001). Complete preoperative and 1-year postoperative pain (VAS) (n = 274) and functional outcome scores (n = 185) were collected when possible. The mean pain (VAS) decreased from 7/10 to 3/10 postoperatively (all P < .01). The mean SF-36 including physical component summary score (PCS) and mental component summary score (MCS) increased from 34 and 44 to 45 and 51, respectively (P < .01 for both PCS and MCS). The mean FFI improved from 63 to 42 for pain, 63 to 43 for disability, 68 to 44 for activity limitation, and 61 to 41 for total score postoperatively (all P < .01). Postoperative morbidity included weakness of ankle plantarflexion (N = 11/320; 3.1% respectively) and sural nerve dysesthesia (N = 10/320; 3.4%). Wound complications or Achilles tendon rupture did not occur. There was no difference in the average improvement in ankle dorsiflexion, outcome scores, and rate of complications between the isolated and combined procedures. Endoscopic gastrocnemius recession demonstrated promising results in the treatment of isolated gastrocnemius contracture. Ankle dorsiflexion was significantly improved with minimal morbidity. The procedure was found effective in improving functional outcomes and relieving pain as a sole operative treatment and as a part of combined procedures in our patients. Level IV, case series.

Reconstruction of the Stage IIA Adult-acquired Flatfoot Deformity

Stage IIA adult-acquired flatfoot deformity is defined by a characteristic collapse of the medial arch with passively correctible hindfoot valgus, limited forefoot abduction, and forefoot varus deformities. Operative treatment for symptomatic patients who fail conservative therapy is determined by the deformities present, but can include a medializing calcaneal osteotomy, flexor digitorum tendon transfer to the navicular, gastrocnemius recession, repair of the posterior tibial tendon, and spring ligament as well as medial column procedures including a Cotton osteotomy or first tarsometatarsal fusion. These procedures have been shown to restore alignment radiographically and to improve both pain and quality of life. In this article, we describe our technique for reconstruction of the stage IIA flatfoot and address common concerns that occur both intraoperatively and postoperatively.

Foot and Ankle Reconstruction for Adult Acquired Flatfoot after Ligamentous Ankle Injury

Introduction: Ankle syndesmosis injuries typically occur when the foot is forced upward and outward. Syndesmosis of the ankle is the joint that connects the tibia and fibula and allows these two bones to work together to provide stability to the lower leg. Case: 24 year old active duty female service member presented to Womack Army Medical Center for left ankle pain approximately 12 weeks after incurring an injury while playing basketball. She reported increased pain with activity and no improvement when using a brace. Imaging studies performed on the weight bearing left leg, ankle, and foot revealed a healed proximal fibular fracture, syndesmosis widening with lateral shift and medial space widening, and decreased longitudinal arch height. A magnetic resonance imaging revealed a deltoid ligament tear and widening of the syndesmosis, but showed no tibialis posterior tendinopathy. The patient was taken to the operating room for open reduction internal fixation of the syndesmosis with a medial displacement calcaneal osteotomy, deltoid ligament repair, gastrocnemius recession, and medial cuneiform opening wedge osteotomy. Discussion: The coexistence of syndesmosis and deltoid ligament injuries modifies ankle joint motion and significantly destabilizes the ankle joint. Radiographs of the affected limb to rule out any fracture are important; however, stress radiographs may be needed to accurately determine stability of the ankle joint as clinical examination cannot assess or diagnose deltoid ligament injury.

Silfverskiöld’s Test in Total Ankle Replacement With Gastrocnemius Recession

For patients undergoing primary total ankle replacement (TAR) with an equinus contracture, gastrocnemius recession may be performed to increase dorsiflexion. We examined whether gastrocnemius recession would significantly increase dorsiflexion even with a negative Silfverskiöld test. Data were prospectively collected on a consecutive series of 29 patients who underwent TAR. All were deemed to require lengthening of the posterior soft tissue structures for unacceptable equinus contracture. Once each patient was under anesthesia, Silfverskiöld's test was performed. A digital photograph was taken with the ankle at maximum passive dorsiflexion with the knee at 0 degrees of flexion and again with the knee at 30 degrees of flexion. Strayer gastrocnemius recession was then performed in standard fashion in every patient. After recession, Silfverskiöld's test was again performed with photographs obtained in the same manner. The digital photographs demonstrating the results of the preoperative and postoperative Silfverskiöld's tests in both knee positions were analyzed and the degree of ankle dorsiflexion measured. Regardless of the results of Silfverskiöld's test, after gastrocnemius recession, patients had an average increase of 12.6 ± 1.6 degrees of dorsiflexion with the knee extended compared to the same position preoperatively (P < .0001) and an increase of 10.1 ± 2.0 degrees with the knee flexed (P < .001). In 6 patients Silfverskiöld's test was markedly positive preoperatively; in this group, recession resulted in an average increase of dorsiflexion of 17.8 ± 3.6 degrees with the knee extended (P = .004) and 13.4 ± 5.4 degrees with the knee flexed (P = .055). For the remaining 23 patients with a negative preoperative Silfverskiöld's test, dorsiflexion increased by 11.3 ± 1.6 (P < .0001) and 9.3 ± 2.2 degrees (P = .0003) with the knee extended and flexed, respectively. Our data show that a gastrocnemius recession resulted in a significant, reproducible increase in dorsiflexion regardless of the results of the Silfverskiöld test while avoiding potential push-off and plantarflexion weakness associated with an Achilles lengthening. Level IV, case series.

One side or two?

One side or two?

Early Weightbearing Using Achilles Suture Bridge Technique for Insertional Achilles Tendinosis: A Review of 43 Patients

Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the surgical treatment of insertional Achilles tendinosis.

Gastrocnemius Recession for Chronic Noninsertional Achilles Tendinopathy

In patients with chronic Achilles tendinopathy, several operative techniques have been described for treatment. A case report has shown that gastrocnemius recession as treatment can normalize MRI findings and relieve clinical symptoms consistent with chronic Achilles tendinopathy. The purpose of this study was to present the results of the treatment of chronic Achilles tendinopathy with gastrocnemius recession. Of 12 patients, 8 (7 females, 1 male) who underwent gastrocnemius recession for refractory Achilles tendinopathy between July 2004 and January 2009 were available for follow-up. All patients filled out a SF-36 health survey, a foot function index, an AOFAS ankle and hindfoot scale, and a simple survey formulated by our group of investigators. Of the 8 patients, 7 were available to return for clinical assessment. Patients had an average age of 49.9 years (SD = 11.6) at the time of surgery and average time of follow-up was 34.6 months (SD = 18.1). The mean pain score (VAS 0-10 scale) significantly decreased from 7.3 (SD = 1.7) preoperatively to 1 (SD = 1.8) postoperatively at the time of follow-up (P < .001). The mean AOFAS ankle and hindfoot score was 94.4 (SD = 9.8), which was significantly improved when compared with previously published scores for patients who underwent Achilles debridement with FHL transfer (P = .007). All 8 categories on the SF-36 health survey showed no significant difference with published data for US population values and previously published data for patients who underwent FHL transfer. 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.

Isolated Contracture and Gastrocnemius Recession

Isolated Contracture and Gastrocnemius Recession

Authors’ Response: Current Concepts Review: Isolated Gastrocnemius Contracture and Gastrocnemius Recession

Authors’ Response: Current Concepts Review: Isolated Gastrocnemius Contracture and Gastrocnemius Recession