ABSTRACT
Selective proximal recession of the medial gastrocnemius head has clear advantages
over other approaches and can be performed as a single or combined open procedure
for many indications. The purpose of this study was to evaluate the safety and efficacy
of a new technique based on ultrasound-guided ultraminimally invasive proximal gastrocnemius
recession. We performed a pilot study with 16 cadavers to ensure that the technique
was effective and safe; we then prospectively performed gastrocnemius recession in
12 patients (23 cases) with gastrocnemius contracture associated with other indications.
We evaluated pre- and postprocedure dorsiflexion, clinical outcomes (based on the
visual analog scale and American Orthopedic Foot and Ankle Society scores), and potential
complications. We achieved effective release of the proximal medial gastrocnemius
tendon in all cases, with no damage to other tissue. Ankle dorsiflexion increased
12° (range 6° to 18°) (p = .05) and was maintained throughout follow-up. The mean preoperative visual analog
scale score was 7 (range 5 to 9), which improved to 1 (range 0 to 2) (p = .01). The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score improved
from a mean of 25 (range 20 to 40) to 85 (range 80 to 100) at 6 months and 90 at 12
months (p = .01). No major complications were observed. We considered the technique to be safe
and effective for ultrasound-guided ultraminimally invasive proximal-medial gastrocnemius
recession using a 1-mm incision in vivo. This novel technique is an alternative to
open techniques, with encouraging results and with the potential advantages of reducing
pain and obviating lower limb ischemia and deep anesthesia, thus decreasing complications
and contraindications and accelerating recovery, although further studies are required.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot.J Bone Joint Surg Am. 1999; 81: 535-538
- The surgical management of equinus in the adult acquired flatfoot.Clin Podiatr Med Surg. 2007; 24: 667-685
- Equinus deformity as a factor in forefoot nerve entrapment.J Am Podiatr Med Assoc. 2005; 95: 464-468
- Endoscopic gastrocnemius recession for treating equinus in pediatric patients.Clin Orthop Relat Res. 2010; 468: 1033-1038
- Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening.Foot Ankle Int. 2011; 32: 375-379
- Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession.Int Orthop. 2013; 37: 1845-1850
- Gastrocnemius recession for chronic non-insertional Achilles tendinopathy.Foot Ankle Int. 2013; 34: 481-485
- Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status.Skeletal Radiol. 2010; 39: 425-434
- Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy.Med Sci Sports Exerc. 2002; 34: 573-580
- Ultrasound-guided gastrocnemius recession: a new ultra-minimally invasive surgical technique.BMC Musculoskelet Disord. 2016; 17: 409
- Technique, indications, and results of proximal medial gastrocnemius lengthening.Foot Ankle Clin N Am. 2014; 19: 795-806
- The effect on ankle dorsiflexion of gastrocnemius recession.Foot Ankle Int. 2002; 23: 26-29
- Endoscopic gastrocnemius recession: preliminary report on 18 cases.J Foot Ankle Surg. 2004; 43: 302-306
- Endoscopic gastrocnemius recession for the treatment of isolated gastrocnemius contracture: a prospective study on 320 consecutive patients.Food Ankle Int. 2014; 35: 747-756
- Gastrocnemius recession for foot and ankle conditions in adults: evidence-based recommendations.Foot Ankle Surg. 2015; 21: 77-85
- Isolated recession of the gastrocnemius muscle: the Baumann procedure.Foot Ankle Int. 2007; 28: 1154-1159
- Gastrocnemius soleus recession: a simpler, more limited approach.J Am Podiatr Med Assoc. 2005; 95: 18-25
- Reduction of the uncrossed two joints muscles of the leg to one joint muscles in spastic children.Acta Scandinavia. 1923; 56: 315-330
- Comparaison de deux types de liberation proximale des gastrocnémiens medial et lateral, versus gastrocnémien medial isolé.Med Chir Pied. 2006; 22: 156
- Resultats de la liberation proximale des gastrocnemius.Med Chir Pied. 2006; 22: 151-156
- Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis.Foot Ankle Int. 2012; 33: 14-19
- Gastrocnemius proximal release with minimal incision: a modified technique.Foot Ankle Int. 2012; 33: 750-762
- The gastrocnemius. A new paradigm for the human foot and ankle.Foot Ankle Clin N Am. 2014; 19: 637-647
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
- Ultrasound-guided plantar fascia release with needle: a novel surgical technique.Open J Orthoped. 2016; 6: 159-170
- Ultra-minimally invasive sonographically guided carpal tunnel release anatomic study of a new technique.J Ultrasound Med. 2013; 32: 131-142
- Surgical anatomy of the proximal release of the gastrocnemius: a cadaveric study.Foot Ankle Int. 2009; 30: 1202-1206
- Gastrocsoleus recession techniques: an anatomical and biomechanical study in human cadavers.Bone Joint J. 2014; 96-B: 778-782
- Lengthening of the gastrocnemius-soleus complex: an anatomical and biomechanical study in human cadavers.J Bone Joint Surg Am. 2013; 95: 1489-1496
- Ultrasound-guided plantar fascia release: a new ultra-minimally invasive surgical technique.AAOS Award Winner, Educational Media, New Orleans2014
- Achilles non-insertional tendinopathy. Ultrasound-guided ultra-minimally invasive surgical techniques.AAOS, Educational Media, Las Vegas2015
Article info
Publication history
Published online: July 23, 2019
Footnotes
Financial Disclosure: None reported
Conflict of Interest: None reported.
Identification
Copyright
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
