Skip to main content
Top
Published in: International Orthopaedics 6/2015

01-06-2015 | Original Paper

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

Authors: Gowreeson Thevendran, Lee Bing Howe, Kannan Kaliyaperumal, Christopher Fang

Published in: International Orthopaedics | Issue 6/2015

Login to get access

Abstract

Background

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.

Methods

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.

Results

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.).

Conclusion

This study demonstrates that the endoscopic gastrocnemius recession procedure performed through a single portal technique has low morbidity with good to excellent results.

Level of Evidence

Level III, retrospective study.
Literature
1.
go back to reference Macklin K, Healy A, Chockalingam N (2012) The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters. Foot (Edinb) 22(1):10–17CrossRef Macklin K, Healy A, Chockalingam N (2012) The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters. Foot (Edinb) 22(1):10–17CrossRef
2.
go back to reference Aronow MS, Diaz-Doran V, Sullivan RJ, Adams DJ (2006) The effect of triceps surae contracture force on plantar foot pressure distribution. Foot Ankle Int 27(1):43–52PubMed Aronow MS, Diaz-Doran V, Sullivan RJ, Adams DJ (2006) The effect of triceps surae contracture force on plantar foot pressure distribution. Foot Ankle Int 27(1):43–52PubMed
3.
go back to reference DiGiovanni CW, Kuo R, Tejwani N et al (2002) Isolated gastrocnemius tightness. J Bone Joint Surg Am 84-A(6):962–970PubMed DiGiovanni CW, Kuo R, Tejwani N et al (2002) Isolated gastrocnemius tightness. J Bone Joint Surg Am 84-A(6):962–970PubMed
4.
go back to reference Downey MS, Banks AS (1989) Gastrocnemius recession in the treatment of nonspastic ankle equinus. A retrospective study. J Am Podiatr Med Assoc 79(4):159–174PubMedCrossRef Downey MS, Banks AS (1989) Gastrocnemius recession in the treatment of nonspastic ankle equinus. A retrospective study. J Am Podiatr Med Assoc 79(4):159–174PubMedCrossRef
5.
go back to reference Meszaros A, Caudell G (2007) The surgical management of equinus in the adult acquired flatfoot. Clin Podiatr Med Surg 24(4):667–685PubMedCrossRef Meszaros A, Caudell G (2007) The surgical management of equinus in the adult acquired flatfoot. Clin Podiatr Med Surg 24(4):667–685PubMedCrossRef
6.
go back to reference Hastings MK, Mueller MJ, Sinacore DR, Salsich GB, Engsberg JR, Johnson JE (2000) Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus. J Orthop Sports Phys Ther 30(2):85–90PubMedCrossRef Hastings MK, Mueller MJ, Sinacore DR, Salsich GB, Engsberg JR, Johnson JE (2000) Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus. J Orthop Sports Phys Ther 30(2):85–90PubMedCrossRef
7.
go back to reference Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE (2003) Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am 85-A(8):1436–1445PubMed Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE (2003) Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am 85-A(8):1436–1445PubMed
8.
go back to reference Salsich GB, Mueller MJ, Hastings MK, Sinacore DR, Strube MJ, Johnson JE (2005) Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther 85(1):34–43PubMed Salsich GB, Mueller MJ, Hastings MK, Sinacore DR, Strube MJ, Johnson JE (2005) Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther 85(1):34–43PubMed
9.
go back to reference Maskill JD, Bohay DR, Anderson JG (2010) Gastrocnemius recession to treat isolated foot pain. Foot Ankle Int 31(1):19–23PubMedCrossRef Maskill JD, Bohay DR, Anderson JG (2010) Gastrocnemius recession to treat isolated foot pain. Foot Ankle Int 31(1):19–23PubMedCrossRef
10.
go back to reference Maffulli N, Del Buono A (2015) Release of the medial head of the gastrocnemius for Achilles tendinopathy in sedentary patients: a retrospective study. Int Orthop 39(1):61–5PubMedCrossRef Maffulli N, Del Buono A (2015) Release of the medial head of the gastrocnemius for Achilles tendinopathy in sedentary patients: a retrospective study. Int Orthop 39(1):61–5PubMedCrossRef
11.
go back to reference Monteagudo M, Maceira E, Garcia-Virto V, Canosa R (2013) Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop 37(9):1845–1850PubMedCentralPubMedCrossRef Monteagudo M, Maceira E, Garcia-Virto V, Canosa R (2013) Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop 37(9):1845–1850PubMedCentralPubMedCrossRef
12.
go back to reference DiGiovanni CW, Langer P (2007) The role of isolated gastrocnemius and combined Achilles contractures in the flatfoot. Foot Ankle Clin 12(2):363–379, viiiPubMedCrossRef DiGiovanni CW, Langer P (2007) The role of isolated gastrocnemius and combined Achilles contractures in the flatfoot. Foot Ankle Clin 12(2):363–379, viiiPubMedCrossRef
13.
go back to reference Singh D (2013) Nils Silfverskiold (1888–1957) and gastrocnemius contracture. Foot Ankle Surg 19(2):135–138PubMedCrossRef Singh D (2013) Nils Silfverskiold (1888–1957) and gastrocnemius contracture. Foot Ankle Surg 19(2):135–138PubMedCrossRef
14.
go back to reference Takahashi S, Shrestha A (2002) The Vulpius procedure for correction of equinus deformity in patients with hemiplegia. J Bone Joint Surg (Br) 84(7):978–980CrossRef Takahashi S, Shrestha A (2002) The Vulpius procedure for correction of equinus deformity in patients with hemiplegia. J Bone Joint Surg (Br) 84(7):978–980CrossRef
15.
go back to reference Stoffel A (1913) The treatment of spastic contractures. J Bone Joint Surg 210(4):611–644 Stoffel A (1913) The treatment of spastic contractures. J Bone Joint Surg 210(4):611–644
16.
go back to reference Silver CM, Simon SD (1959) Gastrocnemius-muscle recession (Silfverskiold operation) for spastic equinus deformity in cerebral palsy. J Bone Joint Surg Am 41-A:1021–1028PubMed Silver CM, Simon SD (1959) Gastrocnemius-muscle recession (Silfverskiold operation) for spastic equinus deformity in cerebral palsy. J Bone Joint Surg Am 41-A:1021–1028PubMed
17.
go back to reference Strayer LM Jr (1950) Recession of the gastrocnemius; an operation to relieve spastic contracture of the calf muscles. J Bone Joint Surg Am 32-A(3):671–676PubMed Strayer LM Jr (1950) Recession of the gastrocnemius; an operation to relieve spastic contracture of the calf muscles. J Bone Joint Surg Am 32-A(3):671–676PubMed
18.
go back to reference Delp SL, Statler K, Carroll NC (1995) Preserving plantar flexion strength after surgical treatment for contracture of the triceps surae: a computer simulation study. J Orthop Res 13(1):96–104PubMedCrossRef Delp SL, Statler K, Carroll NC (1995) Preserving plantar flexion strength after surgical treatment for contracture of the triceps surae: a computer simulation study. J Orthop Res 13(1):96–104PubMedCrossRef
19.
go back to reference Pinney SJ, Hansen ST Jr, Sangeorzan BJ (2002) The effect on ankle dorsiflexion of gastrocnemius recession. Foot Ankle Int 23(1):26–29PubMed Pinney SJ, Hansen ST Jr, Sangeorzan BJ (2002) The effect on ankle dorsiflexion of gastrocnemius recession. Foot Ankle Int 23(1):26–29PubMed
20.
go back to reference Trevino S, Gibbs M, Panchbhavi V (2005) Evaluation of results of endoscopic gastrocnemius recession. Foot Ankle Int 26(5):359–364PubMed Trevino S, Gibbs M, Panchbhavi V (2005) Evaluation of results of endoscopic gastrocnemius recession. Foot Ankle Int 26(5):359–364PubMed
21.
go back to reference Phisitkul P, Rungprai C, Femino JE, Arunakul M, Amendola A (2014) Endoscopic gastrocnemius recession for the treatment of isolated gastrocnemius contracture: a prospective study on 320 consecutive patients. Foot Ankle Int 35(8):747–756PubMedCrossRef Phisitkul P, Rungprai C, Femino JE, Arunakul M, Amendola A (2014) Endoscopic gastrocnemius recession for the treatment of isolated gastrocnemius contracture: a prospective study on 320 consecutive patients. Foot Ankle Int 35(8):747–756PubMedCrossRef
22.
go back to reference Yeap EJ, Shamsul SA, Chong KW, Sands AK (2011) Simple two-portal technique for endoscopic gastrocnemius recession: clinical tip. Foot Ankle Int 32(8):830–833PubMedCrossRef Yeap EJ, Shamsul SA, Chong KW, Sands AK (2011) Simple two-portal technique for endoscopic gastrocnemius recession: clinical tip. Foot Ankle Int 32(8):830–833PubMedCrossRef
23.
go back to reference Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW (2003) Endoscopic gastrocnemius recession: evaluation in a cadaver model. Foot Ankle Int 24(8):607–613PubMed Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW (2003) Endoscopic gastrocnemius recession: evaluation in a cadaver model. Foot Ankle Int 24(8):607–613PubMed
24.
go back to reference Angthong C, Kanitnate S (2012) Dual-portal endoscopic gastrocnemius recession for the treatment of severe posttraumatic equinus deformity: a case series and a review of technical modifications. J Nippon Med Sch 79(3):198–203PubMedCrossRef Angthong C, Kanitnate S (2012) Dual-portal endoscopic gastrocnemius recession for the treatment of severe posttraumatic equinus deformity: a case series and a review of technical modifications. J Nippon Med Sch 79(3):198–203PubMedCrossRef
25.
go back to reference DiDomenico LA, Adams HB, Garchar D (2005) Endoscopic gastrocnemius recession for the treatment of gastrocnemius equinus. J Am Podiatr Med Assoc 95(4):410–413PubMedCrossRef DiDomenico LA, Adams HB, Garchar D (2005) Endoscopic gastrocnemius recession for the treatment of gastrocnemius equinus. J Am Podiatr Med Assoc 95(4):410–413PubMedCrossRef
26.
go back to reference Saxena A, Widtfeldt A (2004) Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 43(5):302–306PubMedCrossRef Saxena A, Widtfeldt A (2004) Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 43(5):302–306PubMedCrossRef
27.
28.
go back to reference Schroeder SM (2012) Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade. J Foot Ankle Surg 51(6):714–719PubMedCrossRef Schroeder SM (2012) Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade. J Foot Ankle Surg 51(6):714–719PubMedCrossRef
29.
go back to reference Saxena A, Gollwitzer H, Widtfeldt A, DiDomenico LA (2007) Endoscopic gastrocnemius recession as therapy for gastrocnemius equinus. Z Orthop Unfall 145(4):499–504PubMed Saxena A, Gollwitzer H, Widtfeldt A, DiDomenico LA (2007) Endoscopic gastrocnemius recession as therapy for gastrocnemius equinus. Z Orthop Unfall 145(4):499–504PubMed
30.
go back to reference Roukis TS, Schweinberger MH (2010) Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: an observational case series. J Foot Ankle Surg 49(1):68–70PubMedCrossRef Roukis TS, Schweinberger MH (2010) Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: an observational case series. J Foot Ankle Surg 49(1):68–70PubMedCrossRef
31.
go back to reference Booth BA, Mistovich RJ, Janout M, Stills HF, Laughlin RT (2009) Fatty infiltration of the gastrocsoleus after tendo-Achilles lengthening and gastrocnemius recession in a rabbit model. Foot Ankle Int 30(8):778–782PubMedCrossRef Booth BA, Mistovich RJ, Janout M, Stills HF, Laughlin RT (2009) Fatty infiltration of the gastrocsoleus after tendo-Achilles lengthening and gastrocnemius recession in a rabbit model. Foot Ankle Int 30(8):778–782PubMedCrossRef
Metadata
Title
Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients
Authors
Gowreeson Thevendran
Lee Bing Howe
Kannan Kaliyaperumal
Christopher Fang
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 6/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2723-9

Other articles of this Issue 6/2015

International Orthopaedics 6/2015 Go to the issue