Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

Marcos, Álvaro Iborra; Martínez, Manuel Villanueva; Díaz, Homid Fahandezh-Saddi

doi:10.1186/s13018-022-03318-8

Cited by 4 publications

(2 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The technique presented in this article, which had previously been performed on cadaveric specimens [ 25 ], is as effective as all other available approaches. The hook-knife is replaced by a 16G Abbocath needle, which minimizes injury and the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Iborra,

Villanueva,

Fahandezh-Saddi Díaz

2024

J Orthop Surg Res

View full text Add to dashboard Cite

Background Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. Methods and results We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle. Results Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months. Conclusion Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In 2022, Iborra et al [ 25 ]. Described the ultrasound-guided gastrocnemius recession technique using a needle in cadaver specimens.…”

Section: Introductionmentioning

confidence: 99%

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Iborra,

Villanueva,

Fahandezh-Saddi Díaz

2024

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

Prise en charge chirurgicale d’allongement de la chaîne postérieure

Beldame

2024

Revue du Podologue

View full text Add to dashboard Cite

Triceps surae shortening in children

Sapogovskiy

2024

Pediatr Traum Orthop Reconstr Surg

View full text Add to dashboard Cite

BACKGROUND: The triceps surae is the main muscle that exerts propulsion power during walking and running. Its retraction changes the biomechanics of the foot, alters locomotion, and results in the secondary development of flatfoot deformity. Literature data on the clinical assessment of triceps surae retraction vary. AIM: To assess the threshold value of foot dorsiflexion in different clinical assessment methods of determining Achilles tendon shortening. MATERIALS AND METHODS: The study included the clinical assessment results of foot dorsiflexion in 167 patients (325 feet) with flatfeet aged 7–18 years. The foot dorsiflexion evaluation consisted of the assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilization of the tarsal joints. To determine the involvement of the gastrosoleus complex in the pathological process, foot dorsiflexion was assessed with knee joint flexion and extension. The obtained data were subjected to correlation, regression, and Bland–Altman analyses. RESULTS: Strong correlations were found when foot dorsiflexion was assessed with the same knee joint position (assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilized tarsal joints and knee joint flexion; the same tests with knee joint extension). Moderate correlations were noted when comparing foot dorsiflexion with knee joint extension and flexion. In the regression analysis, formulas were obtained according to which the threshold values of foot dorsiflexion were calculated in various variants during knee joint flexion and extension, indicating the retraction of the triceps surae: isolated foot dorsiflexion with knee joint extension 20°, isolated foot dorsiflexion with knee flexion 36°, and foot dorsiflexion with tarsal joint stabilization and knee extension 23°. CONCLUSIONS: Retraction of triceps surae in children with flatfeet equally involves the gastrocnemius and soleus. Differences in the magnitude of foot dorsiflexion with knee joint flexion and extension are the main factors in the retraction of the triceps surae to the gastrocnemius muscle.

show abstract

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

Cited by 4 publications

References 40 publications

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Prise en charge chirurgicale d’allongement de la chaîne postérieure

Triceps surae shortening in children

Contact Info

Product

Resources

About