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Ehrenborg N, Davis C, Tremoulis J, Bussert B, Cheney NA, O'Connor P. Gastrocnemius recession: Discrepancies in the literature. J Orthop 2024; 55:11-15. [PMID: 38646466 PMCID: PMC11026530 DOI: 10.1016/j.jor.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
A gastrocnemius contracture is a common problem that results in decreased ankle dorsiflexion that contributes to an array of foot and ankle ailments. A common surgical treatment for this condition is a gastrocnemius recession (GR). Many adaptations of the original procedure have been described. Misinterpretations of proper GR procedures have potentially caused confusion when selecting a treatment. This paper proposes to identify errors between the use of GR and gastrocnemius-soleus recession (GSR) procedure techniques in the current literature. A systematic literature review was performed in June 2021, using the PubMed database and select orthopedic texts. Only studies that met the established criteria and either correctly or incorrectly described a GR or GSR procedure were included. After applying exclusion criteria, 108 publications were included. These articles and texts were reviewed for surgical technique and terminology errors in accordance with established parameters. The articles were classified as either: "Correct" or "Incorrect." Of the 108 publications and texts included, 18 articles incorrectly described either a GR or a GSR (16.67%). Ninety articles correctly described either a GR or a GSR (83.33%). The literature supports the use of a GR to treat a gastrocnemius contracture. Inaccurate articles create confusion as to what exactly a GR entails. Sources of ambiguity included terminology, inconsistent anatomical zone definition, and technique selection. Due to this confusion, it is suspected that patient outcomes can be impacted. Postoperative outcomes of GSR patients are worse than GR patients. Further investigation is necessary to determine if performing the incorrect procedure negatively affects patient outcomes.
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Affiliation(s)
| | - Connor Davis
- Ohio University Heritage College of Osteopathic Medicine, Athens, USA
| | - Jacob Tremoulis
- Ohio University Heritage College of Osteopathic Medicine, Athens, USA
| | - Brett Bussert
- Ohio University Heritage College of Osteopathic Medicine, Athens, USA
| | | | - Patrick O'Connor
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, USA
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Cooper MT. Common Painful Foot and Ankle Conditions: A Review. JAMA 2023; 330:2285-2294. [PMID: 38112812 DOI: 10.1001/jama.2023.23906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Importance Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment. Observations Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used. Conclusions and Relevance Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.
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Purnell J, Johnson AH, Cody EA. Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study. Foot Ankle Int 2023; 44:1105-1111. [PMID: 37772848 DOI: 10.1177/10711007231198508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Insertional Achilles tendinopathy (IAT) is a common condition causing pain and dysfunction. Patients with diabetes, hyperlipidemia, hypothyroidism, and obesity are at increased risk of developing IAT. These comorbidities also carry an increased risk of wound healing complications following surgery. Therefore, there is a need for alternative management strategies for this high-risk patient population. This study investigated the potential role of isolated GR in patients with chronic IAT. METHODS This study is a single-institution retrospective review of adult patients who underwent isolated GR to address chronic IAT with a minimum 1-year follow-up. Demographics, complications, radiographic findings, and preoperative and postoperative patient-reported outcome scores (PROs) were collected. The primary outcome was improvement in PROMIS scores from preoperative to postoperative. Secondary outcomes were complication and reoperation rates. RESULTS Sixteen patients underwent open GR with a mean follow-up of 2.7 years. Postoperative PROMIS domain scores improved significantly from preoperative scores for physical function, pain interference, pain intensity, and global physical function. Two patients (13%) underwent reoperation (open calcaneal exostectomy and tendon debridement) at a mean time of 7 months from gastrocnemius recession. One patient developed a postoperative hematoma that resolved with conservative management. CONCLUSION This single-institution series reports on a small cohort of patients with chronic IAT treated with open GR. We found significant improvement in patient-reported outcomes. Rates of complication and reoperation were low. This study supports the potential use of isolated gastrocnemius recession in IAT patients who, because of age or medical comorbidities, may benefit from a less invasive surgery and faster rehabilitation. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Jennifer Purnell
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - Anne Holly Johnson
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth A Cody
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
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Stellar D, Lyons SR, Ramdass R, Meyr AJ. The Role of Equinus in Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:247-260. [PMID: 36841577 DOI: 10.1016/j.cpm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.
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Affiliation(s)
- Devrie Stellar
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA.
| | - Sean R Lyons
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA
| | - Roland Ramdass
- Foot & Ankle Center, P.C., 912 South Pleasant Valley Road, Winchester, VA 22601, USA; Residency Training Committee Inova Fairfax Medical Campus
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 2nd Floor, 148 North 8th Street, Philadelphia, PA 19107, USA
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Han D, Yan G, Zhao K, Wang Z, Jiang P, Yan L. Design and Analysis of a Three-Dimensional Spindle-Shaped Receiving Coil for a Targeted Therapy Capsule Robot in the Intestine. MICROMACHINES 2022; 13:1884. [PMID: 36363905 PMCID: PMC9694794 DOI: 10.3390/mi13111884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Capsule robots capable of taking wireless power-transfer systems for diagnosis in the intestine enable the ability to avoid invasive detection, which causes damage to tissue. A targeted therapy capsule robot based on a wireless power-transfer system could move actively in the intestine, implementing diseases detection and drug delivery. Compared with traditional telescope, the capsule robot explores without pain to patients. However, the insufficient power supply has become a big issue for a targeted therapy capsule robot. To address this problem, we proposed a new type of three-dimensional spindle-shaped receiving coil that can couple well with unidirectional magnetic fields and supply sufficient energy even when there is a misalignment in position and angle, owing to which the electromagnetic energy decays quickly. The proposed receiving coil could be embedded on the capsule robot, suitable for the capsule size Φ15 mm × 25 mm. To obtain the maximum energy in three-dimensional space, an optimization model was built. The parameters of the receiving coil were optimized and analyzed. Then, the designed receiving coil was verified with an energy-transfer stability analysis based on both attitude angle and position in a bench test. Furthermore, a curved pipe experiment was conducted using a capsule robot prototype with the proposed three-dimensional spindle-shaped receiving coil. The results demonstrated that stable and sufficient power could be supplied by the proposed receiving coil for the capsule robot at any position and any attitude angle between transmitting and receiving coils.
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Affiliation(s)
- Ding Han
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai 200240, China
| | - Guozheng Yan
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai 200240, China
| | - Kai Zhao
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai 200240, China
| | - Zhiwu Wang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai 200240, China
| | - Pingping Jiang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai 200240, China
| | - Lin Yan
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
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Mateen S, Ali S, Meyr AJ. Surgical Anatomy of the Endoscopic Gastrocnemius Recession. J Foot Ankle Surg 2022; 61:686-688. [PMID: 34848108 DOI: 10.1053/j.jfas.2021.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
The objective of this investigation was to analyze the surgical anatomy of the endoscopic gastrocnemius recession procedure with reference to the curved nature of the aponeurosis. A consecutive series of 34 magnetic resonance imaging scans were evaluated under the direction of a musculoskeletal radiologist. An angular calculation of the effective curvature of the aponeurosis was measured 2 cm distal to the musculotendinous junction based on the maximal posterior excursion and terminal medial and lateral edges. A frequency count was additionally performed of the number of deep intramuscular septa extending from the aponeurosis, as well as a description of the location of the neurovascular bundle in this location. The mean effective curvature was 126.5 degrees (standard deviation [SD] = 6.3 degrees, range 115-143 degrees, 95% confidence interval 124.3-128.7 degrees). We observed an average of 1.2 (SD = 0.5, range = 0-2) deep intramuscular septa extending from the aponeurosis, and that 20.6% of neurovascular bundles were located superficial to the aponeurosis in this location. In conclusion, we found that a straight cannula needs to be navigated around an approximate 125-degree angle during performance of the EGR procedure. We think that this information provides evidence of potentially unrecognized complications of this procedure and leads to future investigations demonstrating anatomic and procedural outcomes.
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Affiliation(s)
- Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Sayed Ali
- Professor, Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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Kow RY, Che-Ahmad A, Ayeop MAS, Ahmad MW, Yusof S. A novel technique of isolated gastrocnemius recession: A cadaveric comparison with Strayer procedure. J Orthop Surg (Hong Kong) 2022; 29:23094990211043987. [PMID: 34753329 DOI: 10.1177/23094990211043987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Strayer's gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety and at the same time compare this novel technique with the existing Strayer procedure biomechanically. METHODS Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques. RESULTS There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829). CONCLUSIONS Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them. LEVEL OF EVIDENCE Level II, randomized controlled trial.
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Affiliation(s)
- Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, 162083International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Aminudin Che-Ahmad
- Department of Orthopaedics, Traumatology & Rehabilitation, 162083International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohd Adham Shah Ayeop
- Department of Orthopaedics, Traumatology & Rehabilitation, 162083International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Muhammad Wafiuddin Ahmad
- Department of Orthopaedics, Traumatology & Rehabilitation, 162083International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Shahril Yusof
- Department of Orthopaedics, Traumatology & Rehabilitation, 162083International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening. J Pediatr Orthop 2022; 42:e201-e205. [PMID: 34995262 DOI: 10.1097/bpo.0000000000002020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI). METHODS Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut. RESULTS Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury. CONCLUSIONS The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy. LEVEL OF EVIDENCE Level III.
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Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:4189-4197. [PMID: 35821527 PMCID: PMC9668924 DOI: 10.1007/s00167-022-07039-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
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.
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Walther M, Hörterer H, Harrasser N, Röser A, Gottschalk O. Minimal-invasive Komponenten der Therapie der Tibialis-posterior-Insuffizienz des Erwachsenen. DER ORTHOPADE 2020; 49:962-967. [DOI: 10.1007/s00132-020-03990-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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