Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

Abstract

Purpose This systematic review aims to summarise the outcomes of gastrocnemius release in the management of Achilles Tendinopathy. Methods A systematic review was performed according to PRISMA guidelines. A computer-based search was performed in PubMed, Embase, Cinahl, Scopus and ISI Web of Science. Two independent reviewers performed both title/abstract and full-text screening according to a-priori selection criteria. English-language original research studies reporting outcomes for gastrocnemius recession in patients with Achilles tendinopathy were included. Study quality and risk of bias were assessed using the MINORS criteria. Results Of the 229 articles identified following database searching, nine studies describing 145 cases of gastrocnemius recession were included in the review. Clinically important differences were reported across a range of validated patient reported outcome scores including VISA-A, FFI, FAAM and VAS pain score. Outcomes appear to be superior in patients with noninsertional Achilles tendinopathy, however further research is required to confirm this. Studies also reported an increase in ankle dorsiflexion range of motion and a good rate of return to sport/work. The overall complication rate was 10/123 (8.1%), with sural nerve injury being the most common complication, occurring in 5/123 (4.1%) of cases. Conclusion The results of this review suggest gastrocnemius release to be an effective treatment option in the management of patients with Achilles tendinopathy, who have gastrocnemius contracture and have previously failed to respond adequately to non-operative treatment. Level of evidence Level IV.

Common Painful Foot and Ankle Conditions

“…Complications of surgical debridement include subsequent rupture, deep vein thrombosis, reoperation, neuralgia, and deep infections . As previously described, potential complications of gastrocnemius recession include sural nerve injury and plantarflexion weakness …”

“…Complications of plantar fascia release include wound complications and dorsal midfoot pain, which may be due to altered foot mechanics. Gastrocnemius release may cause sural nerve injury and plantarflexion weakness …”

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study

“…Three of these cases were performed endoscopically. 2 A recent systematic review comprising 697 endoscopic GR surgeries found an overall wound complication rate of 1%, sural neuritis of 3.5%, and plantarflexion weakness of 3.5%. 5 A comparative study of open vs endoscopic GR noted a reduced risk of wound complications in the endoscopic group but comparable clinical and patient-reported outcomes.…”

“…In the last decade, there has been interest in less invasive surgical options for the management of Achilles tendinopathy. 2,11,18,22 One described method is an isolated gastrocnemius recession for patients with contracture. There have been positive improvements in patient outcomes following gastrocnemius recession for patients with noninsertional Achilles tendinopathy (NIAT) who previously failed nonoperative measures.…”

“…2,7,8 To date, there is some limited evidence that patients with IAT may benefit from gastrocnemius recession. 2,11,18,22 In patients who have exhausted conservative measures but continue to demonstrate Achilles tightness clinically via Silfverskiold testing, it is possible that the mechanical overpull of the tendon remains a driving factor in patient symptoms. For this reason, the authors of this study speculate that lengthening the Achilles complex through GR may address the patient’s pain.…”