Endoscopic Gastrocnemius Recession for the Treatment of Gastrocnemius Equinus

DiDomenico, Lawrence A.; Adams, Heiko B.; Garchar, David

doi:10.7547/0950410

Cited by 45 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Significant pain relief and high satisfaction rates were reflected by improvements in the VAS score and either good or very good outcomes on the Likert scale. These results are consistent with those from other studies in the current literature[12,13]. …”

Section: Discussionsupporting

confidence: 94%

See 1 more Smart Citation

Return to physical activity after gastrocnemius recession

Ying¹,

Hong²,

Lee³

et al. 2016

WJO

View full text Add to dashboard Cite

AIMTo prospectively investigate the time taken and patients’ ability to resume preoperative level of physical activity after gastrocnemius recession.METHODSEndoscopic gastrocnemius recession (EGR) was performed on 48 feet in 46 consecutive sportspersons, with a minimum follow-up of 24 mo. The Halasi Ankle Activity Score was used to quantify the level of physical activity. Time taken to return to work and physical activity was recorded. Functional outcomes were evaluated using the short form 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O and M) scores respectively. Patient’s satisfaction and pain experienced were assessed using a modified Likert scale and visual analogue scales. P-value < 0.05 was considered statistically significant.RESULTSNinety-one percent (n = 42) of all patients returned to their preoperative level of physical activity after EGR. The mean time for return to physical activity was 7.5 (2-24) mo. Ninety-eight percent (n = 45) of all patients were able to return to their preoperative employment status, with a mean time of 3.6 (1-12) mo. Ninety-six percent (n = 23) of all patients with an activity score > 2 were able to resume their preoperative level of physical activity in mean time of 8.8 mo, as compared to 86% (n = 19) of patients whose activity score was ≤ 2, with mean time of 6.1 mo. Significant improvements were noted in SF-36, AOFAS hindfoot and modified O and M scores. Ninety percent of all patients rated good or very good outcomes on the Likert scale.CONCLUSIONThe majority of patients were able to return to their pre-operative level of sporting activity after EGR.

show abstract

Section: Discussionsupporting

confidence: 94%

“…Complications of gastrocnemius recession has been well documented in the literature[12]. Of these, the potential for significant plantarflexion weakness attributed to lengthening of the gastroc-soleus muscle unit[13] has generated much concern amongst orthopaedic surgeons and sports medicine practitioners alike.…”

Section: Introductionmentioning

confidence: 99%

Return to physical activity after gastrocnemius recession

Ying¹,

Hong²,

Lee³

et al. 2016

WJO

View full text Add to dashboard Cite

show abstract

“…Schroeder [17] only had a 16°i ncrease in ankle dorsiflexion after endoscopic GSR while another study reported a 13°increase in dorsiflexion [19]. Additionally, DiDomenico et al [5] accomplished an 18°g ain in dorsiflexion after endoscopic GSR. These studies however did not examine patients undergoing tibial lengthening [5,16,17], and so the difference in etiology and timing of onset of gastrocsoleus contracture may have played a role in the different outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…Additionally, DiDomenico et al [5] accomplished an 18°g ain in dorsiflexion after endoscopic GSR. These studies however did not examine patients undergoing tibial lengthening [5,16,17], and so the difference in etiology and timing of onset of gastrocsoleus contracture may have played a role in the different outcomes. The patients in the study of Saxena and Widtfeldt [16] received an endoscopic GSR for preexisting contractures secondary to multiple etiologies, while the studies of Schroeder [17] and DiDomenico et al [5] did not define the etiology of the contracture in their patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…These studies however did not examine patients undergoing tibial lengthening [5,16,17], and so the difference in etiology and timing of onset of gastrocsoleus contracture may have played a role in the different outcomes. The patients in the study of Saxena and Widtfeldt [16] received an endoscopic GSR for preexisting contractures secondary to multiple etiologies, while the studies of Schroeder [17] and DiDomenico et al [5] did not define the etiology of the contracture in their patient populations. In their evaluation of tibial lengthening over an intramedullary nail for short stature, Kim et al [9] reduced equinus contracture by a mean of 10°in those patients who had developed the contracture during the course of lengthening with a GSR after distraction but before removal of the frame.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Rozbruch

Zonshayn

Muthusamy

et al. 2014

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Tibial lengthening is frequently associated with gastrocsoleus contracture and some patients are treated surgically. However, the risk factors associated with gastrocsoleus contracture severe enough to warrant surgery during tibial lengthening and the consistency with which gastrocsoleus recession (GSR) results in a plantigrade foot in this setting have not been well defined. Questions/purposes We compared patients treated with or without GSR during tibial lengthening with respect to (1) clinical risk factors triggering GSR use, (2) ROM gains and patient-reported outcomes, and (3) complications after GSR. Methods Between 2002 and 2011, 95 patients underwent tibial lengthenings excluding those associated with bone loss; 82 (83%) were available for a minimum followup of 1 year. According to our clinical algorithm, we performed GSR when patients had equinus contractures of greater than 10°while lengthening or greater than 0°before or after lengthening. Forty-one patients underwent GSR and 41 did not. Univariate analysis was performed to assess independent associations between surgical characteristics and likelihood of undergoing GSR. A multivariate regression model and receiver operating characteristic curves were generated to adjust for confounders and to establish risk factors and any threshold for undergoing GSR. Chart review determined ROM, patient-reported outcomes, and complications. Results Amount and percentage of lengthening, age, and etiology were risk factors for GSR. Patients with lengthening of greater than 42 mm (odds ratio [OR]: 4.13; 95% CI: 1.82, 9.40; p = 0.001), lengthening of greater than 13% of lengthening (OR: 3.88; 95% CI: 1.66, 9.11; p = 0.001), and congenital etiology (OR: 1.90; 95% CI: 0.86, 4.15; p = 0.109) were more likely to undergo GSR. Adjusting for all other variables, increased amount lengthened (adjusted OR: 1.05; 95% CI: 1.02, 1.07; p \ 0.001) and age (adjusted OR: 1.02; 95% CI: 0.99, 1.05; p = 0.131) were associated with undergoing GSR. Patients gained 24°of ankle dorsiflexion after GSR. Selfreported functional outcomes were similar between patients with or without GSR. Complications included stretch injury to the posterior tibial nerve leading to temporary and partial loss of plantar sensation in two patients.

show abstract

Is there still a place for Achilles tendon lengthening?

Tagoe

Reeves

Bowling

2016

Diabetes Metabolism Res

View full text Add to dashboard Cite

Patients with diabetes and ankle equinus are at particularly high risk for forefoot ulceration because of the development of high forefoot pressures. Stiffness in the triceps surae muscles and tendons are thought to be largely responsible for equinus in patients with diabetes and underpins the surgical rationale for Achilles tendon lengthening (ATL) procedures to alleviate this deformity and reduce ulcer risk. The established/traditional surgical approach is the triple hemisection along the length of the Achilles tendon. Although the percutaneous approach has been successful in achieving increases in ankle dorsiflexion >30°, the tendon rupture risk has led to some surgeons looking at alternative approaches. The gastrocnemius aponeurosis may be considered as an alternative because of the Achilles tendon's poor blood supply. ATL procedures are a balance between achieving adequate tendon lengthening and minimizing tendon rupture risk during or after surgery. After ATL surgery, the first 7 days should involve reduced loading and protected range of motion to avoid rupture, after which gradual reintroduction to loading should be encouraged to increase tendon strength. In summary, there is a moderate level of evidence to support surgical intervention for ankle joint equinus in patients with diabetes and forefoot ulceration that is non-responsive to other conservative treatments. Areas of caution for ATL procedures include the risk for overcorrection, tendon rupture and the tendon's poor blood supply. Further prospective randomized control trials are required to confirm the benefits of ATL procedures over conservative care and the most optimal anatomical sites for surgical intervention.

show abstract

Endoscopic Gastrocnemius Recession for the Treatment of Gastrocnemius Equinus

Cited by 45 publications

References 12 publications

Return to physical activity after gastrocnemius recession

Return to physical activity after gastrocnemius recession

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Is there still a place for Achilles tendon lengthening?

Contact Info

Product

Resources

About