Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 7 , ISSUE 1 ( January-June, 2020 ) > List of Articles

CLINICAL TECHNIQUE

Clinical Tip: Modified Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus Contracture

Kerk Hsiang Chua, Ewe Juan Yeap, Andrew Sands

Keywords : Arthroscopy, Gastrocnemius recession, Gastrocnemius tightness, Minimal invasive

Citation Information : Chua KH, Yeap EJ, Sands A. Clinical Tip: Modified Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus Contracture. J Foot Ankle Surg Asia-Pacific 2020; 7 (1):28-31.

DOI: 10.5005/jp-journals-10040-1117

License: CC BY-NC 4.0

Published Online: 30-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Introduction: Gastrocnemius recession was first described by Vulpius and Stoffel in 1913 for gastrocnemius equinus contracture. Equinus contracture alters the biomechanics of the foot–ankle complex and affects other musculotendinous and ligamentous constrains in the ankle, contributing to many foot and ankle pathologies. The commonly used Strayer's technique has been modified, with the use of endoscopic approaches, to try to reduce the poor cosmesis and reduce the risk of iatrogenic injury to the sural nerve. This article aims to describe a simple uniportal technique that uses readily available arthroscopic instruments to perform endoscopic gastrocnemius recessions (EGRs). Materials and methods: The leg is prepped and draped with a rolled towel under the lateral malleolus. A 10 mm incision is made over this point. The dissection is carried bluntly to the gastrocnemius aponeurosis. The fascia is opened and a McDonald or Freer elevator is introduced between the aponeurosis and the fascia of the soleus. A 4.0 mm 30° arthroscope is inserted beneath the elevator. A half-pipe (Karl Storz, Tuttlingen) is introduced over the scope which protects the sural nerve. The length of the aponeurosis is identified from proximal to distal. At this point, the sural nerve may be visualized at the end of the pipe. A triangle knife (Smith and Nephew, Andover, MA, USA) is then introduced with the sharp edge facing the half-pipe. The knife is then flipped 180° and tension is applied to the aponeurosis by dorsiflexing the foot. The aponeurosis is then released under direct arthroscopic vision.


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  1. Vulpius O, Stoffel A. Tenotomie der end schnen der mm. Gastrocnemius el soleus mittels rutschenlassens nach Vulpius. In: Orthopadische Operationslehre. Stuttgart: Ferdinard Enke; 1913. pp. 29–31.
  2. Roukis T, Schweinberger M. Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: an Observational case series. J Foot Ankle Surg 2010;49(1):68–70. DOI: 10.1053/j.jfas.2009.07.018.
  3. Molund M, Paulsrud Ø, Ellingsen Husebye E, et al. Results after gastrocnemius recession in 73 patients. Foot Ankle Surg 2014;20(4):272–275. DOI: 10.1016/j.fas.2014.07.004.
  4. Pinney S, Sangeorzan B, Hansen S. Surgical anatomy of the gastrocnemius recession (Strayer procedure). Foot Ankle Int 2004;25(4):247–250. DOI: 10.1177/107110070402500409.
  5. Grady J, Kelly C. Endoscopic gastrocnemius recession for Treating equinus in pediatric patients. Clin Orthop Relat Res 2009;468(4): 1033–1038. DOI: 10.1007/s11999-009-1084-3.
  6. Saxena A, Di Giovanni C. Ankle equinus and endoscopic gastrocnemius recession. Minimally Invasive Surgery of the Foot and Ankle. London: Springer; 2010. pp 324–325.
  7. DiGiovanni CW, Kuo R, Tejwani N, et al. Isolated gastrocnemius tightness in patients without neurological impairment. J Bone Joint Surg Am 2002;84(6):962–970. DOI: 10.2106/00004623-200206000-00010.
  8. Pinney SJ, Hansen Jr ST, Sangeorzan BJ. The effect on ankle dorsiflexion of gastrocnemius recession. Foot Ankle Int 2002;23(1): 26–29. DOI: 10.1177/107110070202300105.
  9. Yeap E, Shamsul S, Chong K, et al. Simple two-portal technique for endoscopic gastrocnemius recession: clinical tip. Foot Ankle Int 2011;32(8):830–833. DOI: 10.3113/FAI.2011.0830.
  10. Schroeder S. Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade. J Foot Ankle Surg 2012;51(6):714–719. DOI: 10.1053/j.jfas.2012.08.002.
  11. Thevendran G, Howe L, Kaliyaperumal K, et al. Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients. Int Orthop 2015;39(6):1099–1107. DOI: 10.1007/s00264-015-2723-9.
  12. Cychosz C, Phisitkul P, Belatti D, et al. Gastrocnemius recession for foot and ankle conditions in adults: evidence-based recommendations. Foot Ankle Surg 2015;21(2):77–85. DOI: 10.1016/j.fas.2015. 02.001.
  13. Lui T. Modified endoscopic release of gastrocnemius aponeurosis. J Foot Ankle Surg 2015;54(1):140–142. DOI: 10.1053/j.jfas.2014. 07.014.
  14. Villanueva M, Iborra Á, Rodríguez G, et al. Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique. BMC Musculoskelet Disord 2016;17(1):409. DOI: 10.1186/s12891-016-1265-7.
  15. Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 2004;43(5):302–306. DOI: 10.1053/j.jfas.2004.07.001.
  16. Tashjian R, Appel A, Banerjee R, et al. Endoscopic gastrocnemius recession: evaluation in a cadaver model. Foot Ankle Int 2003;24(8):607–613. DOI: 10.1177/107110070302400807.
  17. Saxena A, Gollwitzer H, Widtfeldt A, et al. Endoscopic gastrocnemius recession as therapy for gastrocnemius equinus. Z Orthop Unfall 2007;145(04):499–504. DOI: 10.1055/s-2007-965385.
  18. Trevino S, Gibbs M, Panchbhavi V. Evaluation of results of endoscopic gastrocnemius recession. Foot Ankle Int 2005;26(5):359–364. DOI: 10.1177/107110070502600503.
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