Complications Associated with Uni-portal Endoscopic Gastrocnemius Recession in a Diabetic Patient Population: An Observational Case Series

The purpose of this article was to report the complications associated with uni-portal endoscopic gastrocnemius recession for surgical treatment of pathologic soft tissue ankle equinus contracture in diabetic patients. This is an observational case series involving a retrospective review of prospectively collected data of 23 uni-portal endoscopic gastrocnemius recessions used to treat pathologic soft tissue ankle equinus contracture in 18 consecutive diabetic patients between November 2006 and January 2009. Each patient underwent uni-portal endoscopic gastrocnemius recession under general or spinal anesthesia with thigh tourniquet control in combination with soft tissue and/or osseous reconstructive foot and/or ankle surgery. Patients were kept non–weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 9 male and 9 female patients with a mean age ± SD of 69.0 ± 7.4-years (range: 47.0 to 71.0 years). There were 11 right and 12 left lower limbs involved, with 5 procedures performed bilateral. Complications included 3 conversions to an open incision secondary to difficulty dissecting through excessive adipose tissue, delayed healing of 3 incision sites in patients with uncontrolled diabetes mellitus at the time of surgery, and 3 undercorrections in patients with spastic contractures. The remainder of the procedures were deemed successful with no saphenous nerve, sural nerve, or lesser saphenous vein related injuries occurring. When properly performed, uni-portal endoscopic gastrocnemius recession represents a safe, reliable, and minimally invasive technique useful for correcting pathologic soft tissue ankle equinus contracture in patients with diabetes. A percutaneous tendo-Achilles lengthening should be performed in patients who have marginal arterial inflow that precludes tourniquet use or have a spastic contracture. An open rather than endoscopic gastrocnemius recession should be performed in patients with excessive adipose tissue. Before surgery, the risk of delayed wound healing should be discussed with patients who have uncontrolled diabetes mellitus and in-patient management with tight glycemic control considered.     

Morbidity Associated With High Gastrocnemius Recession: Retrospective Review of 126 Cases

To evaluate morbidity associated with surgical lengthening of the gastrocnemius, medical records were reviewed retrospectively for 126 patients (mean age, 49.7 years; range, 8-78 years) who had undergone open gastrocnemius recession. Ten patients had isolated recession; 116 had gastrocnemius recession with an additional foot or ankle procedure on the ipsilateral limb. During a mean follow-up period of 19 months (range, 6-50 months), all patients were examined for any postoperative complications associated with the recession. Complications were defined as the presence of postoperative infection, wound dehiscence, nerve problems, decreased muscle strength, scar problems, or calcaneus gait (overlengthening). Uncomplicated outcome was defined as absence of all these complications and return to regular activity, both occurring during a follow-up of at least 6 months. Postsurgical complications developed in 9 (6%) of the 126 patients: 6 (4%) had scar problems, 2 (1.33%) had wound dehiscence, 2 (1.33%) had infection, 3 (2%) had nerve problems, and 1 (0.67%) developed complex regional pain syndrome. No patient complained of either a limp or gait disturbance. Neither persistent decrease in muscle strength nor calcaneus gait was seen. These data suggest that the open gastrocnemius recession procedure has low associated morbidity.     

Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus with a Dedicated EGR System with Retractable Blade

This study examined the effectiveness and safety of a uniportal endoscopic gastrocnemius recession with a specifically designed uniportal endoscopic system. Fifty-three patients underwent 60 endoscopic gastrocnemius recessions. Their mean range of ankle dorsiflexion changed from a preoperative value of –2.9° ± 1.9° to a postoperative value of 12.8° ± 1.7°, for a total increase of 15.7° ± 1.8° of ankle dorsiflexion (p < .001). The average time from skin incision to closure was 4 minutes and 19 ± 33.6 seconds. Overall, 4 (6.67%) cases (procedures) were associated with a complication, including 1 (1.67%) case of triceps surae weakness that resolved after physical therapy. Three (5%) cases developed nerve complications, with 2 (3.33%) cases of transient neuritis that spontaneously resolved at 5 and 8 weeks postoperatively, respectively, and 1 (1.67%) that experienced persistent cutaneous anesthesia in the distribution of the sural nerve along the lateral aspect of the foot up to 4 months postoperatively. There were no cases of wound dehiscence or delayed healing, painful scar formation, infection at the surgical site, hematoma, or deep venous thrombosis. Endoscopic gastrocnemius recession with a uniportal system appears to be safe and effective.     

Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up

The isolated gastrocnemius contracture present in neurologic healthy patients results in a significant limitation of ankle dorsiflexion causing pathologic gait patterns and a greater risk of further foot disorders. Gastrocnemius recession is an established procedure to increase ankle dorsiflexion. However, little evidence is available of the use of gastrocnemius recession in these patients. Complication rates, recurrence of gastrocnemius contracture, and the prevalence of additional foot disorders needs further evaluation. A study group of 64 operated limbs undergoing gastrocnemius recession was evaluated to determine the prevalence of foot disorders, pre- and postoperative ankle dorsiflexion, and incidence of complications. A subgroup of 15 (23.4%) patients without additional operative procedures was examined regarding ankle dorsiflexion, strength (Janda method), sensitivity in the operated limb, and the pre- and postoperative Foot Function Index scores. The prevalence of foot disorders showed pes planus (41%), hallux valgus (38%), metatarsalgia (19%), hammertoe deformity (13%), and symptomatic Haglund exostosis (11%). At 31 months of follow-up, the patients had significantly benefited from increased ankle dorsiflexion of 13.3° ± 7.9° (p < .001). Postoperatively, 16% patients experienced complications. In the subgroup of 15 patients, the follow-up examination after 44 months showed ankle dorsiflexion of 14° ± 7.1°. The plantarflexion strength was 4 of 5 (Janda method). The Foot Function Index score had improved significantly from 65.4 ± 26.5 points to 33.4 ± 19.5 points (p < .001). Patients with isolated gastrocnemius contracture seem to have a high prevalence of symptomatic foot disorders. At a mid-term follow-up examination, gastrocnemius recession (Strayer) was shown to be an effective procedure to significantly improve ankle dorsiflexion, functionality, and pain symptoms. More attention should be given to the development of postoperative complications.     

Endoscopic Gastrocnemius Recession for Treating Equinus in Pediatric Patients

Gastrocnemius recessions have been performed as open or endoscopic procedures. Most of the literature describes the outcomes of these procedures in children with specific neurologic limitations. We report an alternative approach to endoscopic gastrocnemius recessions in neurologically healthy pediatric and adolescent patients whose gastrocnemius equinus could not be corrected nonoperatively. We prospectively followed 23 patients (16 boys, seven girls) who underwent 40 procedures for equinus deformity (n = 22) or osteoarthritis (n = 1). All patients had been directly referred for surgical treatment because all previous nonoperative treatments (stretching, night splints, orthotics, nonsteroidal anti-inflammatory drugs, and physical therapy) had failed. The indications for surgery were patients age 18 years or younger experiencing symptomatic equinus unresponsive to nonoperative care. Pre- and postoperative ankle dorsiflexion were measured. The minimum followup for study inclusion was 1 year (mean, 2.9 years; range, 2–5.1 years). For every patient, dorsiflexion range of motion improved (mean, 15°; standard deviation, 4°). No patient had diminished nerve sensation postoperatively. This technique can be used to correct gastrocnemius equinus in otherwise healthy children who have not benefited from prior nonsurgical treatment.     

Endoscopic gastrocnemius recession: Preliminary report on 18 cases

A technique of endoscopic gastrocnemius recession was evaluated. Fifteen patients undergoing 18 procedures were prospectively studied with a minimum follow-up of 1 year. There were 9 women and 6 men (mean age, 44.1 +/- 22.6 years). One patient had an isolated recession; the others had various adjunctive flatfoot or reconstructive procedures. Pre- and postoperative ankle dorsiflexion was evaluated, as was the amount of time before patients could perform a single-leg heel raise postoperatively. The mean preoperative ankle dorsiflexion with the knee extended was -8.7 degrees +/- 3.5 degrees , which improved from a mean 14.9 degrees at 3 months postoperatively to a mean 6.2 degrees +/- 2.6 degrees . At 12 months postoperatively, this value was 3.6 degrees +/- 1.8 degrees , a net postoperative improvement of 12.6 degrees (P < .00001). Patients were able to perform a single-leg heel raise on an average of 13.0 +/- 6.0 weeks. Complications were mostly related to lateral foot dysesthesia in the distribution of the sural nerve (N = 3). Furrowing of the medial leg was noted in 1 patient. No hematomas or neuromas associated with the portal sites were found. These results show endoscopic gastrocnemius recession to be an acceptable method of lengthening the gastrocnemius complex.     

Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications

BACKGROUND: Wound complications associated with long incisions used to harvest the greater saphenous vein are well documented. Recent reports suggest that techniques of endoscopic vein harvest may result in decreased wound complications. A prospective, nonrandomized study was developed to compare outcomes of open versus endoscopic vein harvest procedures. METHODS: There were 106 patients in the open vein harvest group, and 154 patients in the endoscopic vein harvest group. Patient characteristics and demographics were similar in both groups. Wound complications identified were dehiscence, drainage for greater than 2 weeks postoperatively, cellulitis, hematoma, and seroma/lymphocele. RESULTS: Wound complications were significantly less in the endoscopic vein harvest group (9 of 133, 6.8%) versus the open vein harvest group (26 of 92, 28.3%), p less than 0.001. By multivariable analysis with logistic regression, the open vein harvest technique was the only risk factor for postoperative leg wound complication (relative risk 4.0). CONCLUSIONS: Endoscopic vein harvest offered improved patient outcomes in terms of wound healing compared with the open vein harvest technique.     

踝关节骨折术后腓肠肌挛缩型马蹄足的手术治疗

背景：足踝部创伤可导致患者较长时间的踝部制动及术后软组织粘连,易造成腓肠肌挛缩,从而诱发创伤后马蹄足。若不及时进行合理有效的治疗,容易引发跖腱膜炎、外翻、获得性平足症、前跖痛等并发症。目的：探讨腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩型马蹄足的效果。方法：2011年1月至2013年1月,通过腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩患者26例,男17例,女9例,年龄24~55岁,平均44.3岁。术前对所有患者伸膝及屈膝90°时的踝关节背屈角度进行测量,确诊为踝关节骨折术后腓肠肌挛缩。采用改良的Strayer手术对腓肠肌松解。采用美国足踝外科协会（AOFAS）踝-后足评分评估患足功能。术后再次对伸膝及屈膝90°时的踝关节背屈角度进行测量并与术前比较。结果：21例患者获得随访,随访时间12~24个月,平均17个月。所有切口均一期愈合,无感染,无腓肠神经损伤,无明显疼痛不适。伸膝状态下踝关节背屈角度由术前的0.9°±3.4°恢复到术后的13.6°±2.4°（P＜0.01）。术后AOFAS踝-后足评分为（80.9±5.7）分,与术前（57.6±6.4）分,比较差异亦有统计学意义（P＜0.01）。结论：对于踝关节骨折后并发的腓肠肌型马蹄足,腓肠肌腱松解术操作简单,创伤小,可获得满意疗效。     

The Role of the Plantaris in Intramuscular Gastrocnemius Equinus Correction

Equinus deformity is a common cause of foot and ankle pathology. The purpose of our study was to evaluate the role of the plantaris in equinus. Secondary aims were to describe the role of the plantaris in intramuscular gastrocnemius recession and to determine the prevalence of the plantaris in our patient population. We measured ankle dorsiflexion during the steps of a Baumann-type intramuscular gastrocnemius recession. Eighty-nine patients were enrolled in our study. Fourteen of 89 (15.7%) patients did not have a plantaris. A mean dorsiflexion of 9 (interquartile range 6-12)° was obtained after transection of the plantaris tendon and an additional mean 8 (interquartile range 5-10)° was obtained after recession of the gastrocnemius aponeurosis. There was a strong positive correlation (rs = 0.842) of dorsiflexion increase after plantaris transection and dorsiflexion increase after gastrocnemius recession (p < .00). Linear regression showed that for every one-degree of dorsiflexion increase with plantaris transection, there was a predicted dorsiflexion increase of 0.69° with gastrocnemius recession. These results indicate that the plantaris is a component of equinus deformity.     

Gastrocnemius Recession as an Alternative to Midfoot Arthrodesis for Painful Midfoot Arthritis

Arthrodesis has been described as the gold standard of treatment for midfoot degenerative joint disease (DJD) but has also been associated with nonunion, increased tourniquet times, technical difficulty, and a long postoperative non-weightbearing period. Although it is postulated that a contracted gastrocnemius may cause midfoot pain, there are no reports of using the procedure as a primary treatment for midfoot DJD. The purpose of this study was to determine whether gastrocnemius recession resolved midfoot pain from osteoarthritis and eliminated the need for midfoot arthrodesis. Eleven patients with symptomatic midfoot osteoarthritis and gastrocnemius equinus elected to have a modified Baker gastrocnemius recession as an alternative to a recommended midfoot arthrodesis. Patients were kept non-weightbearing for 2 weeks, transitioned to protected weightbearing in a controlled ankle motion walking boot at weeks 3 to 4, and were allowed to ambulate without restriction in regular shoes at 4 weeks. Preoperative American Orthopedic Foot & Ankle Society (AOFAS) midfoot scores were compared with postoperative scores. Eight (72.7%) of the 11 patients responded to the postoperative survey (n = 8). The mean AOFAS midfoot score improved by 44.63 ± 20.9 points (mean ± standard deviation) (range 18 to 76) or 107% (p < .01). All subjects reported sustained improvement since the preoperative evaluation, with a mean time to follow-up of 28 ± 9.9 months (range 12 to 40). None of the patients surveyed underwent subsequent arthrodesis of the midfoot. The results of this investigation indicate that gastrocnemius recession is an effective treatment to relive symptomatic midfoot osteoarthritis. Foot and ankle surgeons may consider this procedure before performing midfoot arthrodesis to treat this pathology.     

Evaluation of results of endoscopic gastrocnemius recession

BACKGROUND: Gastrocnemius recession is traditionally done as an open procedure. The aim of this retrospective study was to evaluate the safety and efficacy of gastrocnemius recession performed endoscopically. METHODS: The procedure was done in 28 patients (17 men and 11 women), ranging in age from 16 to 72 years (average 47.57, SD 13.86) between January, 2001, and September, 2003. In three patients, the procedure was done bilaterally. Followup ranged from 4 to 36 months (average 22.00, SD 11.84). The procedure was done through a single medial or lateral portal using the 3M Agee Carpal Tunnel Release System (Micro Aire Surgical Instruments, Charlottesville, VA). RESULTS: The initial incision for portal entry was at the wrong level in two of 31 procedures (6.5%), requiring a second incision. The recession could not be accomplished in one of 31 procedures (3.2%), so an open technique was used to complete transection of the gastrocnemius aponeurosis. One patient had a superficial wound infection (3.2%). There was no incidence of sural nerve or Achilles tendon damage. Analysis of results from a modified Olerud and Molander score using a paired student t-test revealed statistically significant improvement (p < or = 0.05) in pain, stiffness, swelling, and overall average score after the procedure. CONCLUSION: The results of endoscopic gastrocnemius recession using the Agee Carpal Tunnel Release System have been encouraging, with limited morbidity. The technique proved both feasible and safe in this study.     

Results after gastrocnemius recession in 73 patients

BackgroundVery few studies describe the clinical results and complications following the surgical procedure of gastrocnemius recession.PurposeTo survey the patient reported outcomes in patients operated with gastrocnemius recession as single procedure for various foot conditions.Material and methods93 patients operated with gastrocnemius recession as single procedure between 2006 and 2011 were detected in the database. 73 patients responded to the invitation for study participation. Questionnaires containing patient reported satisfaction, complications, plantar flexion power and visual analog pain score were used for evaluation of the postoperative result.Results45/73 (62%) patients reported a good or excellent result. 8/73 (11%) patients reported a significant postoperative complication. 16/73 (22%) patients noted reduced or severely reduced plantar flexion power after surgery. VAS pain score significantly decreased from 7.0 before surgery to 1.8 (p =0.015) after surgery for patients with plantar fasciitis (n =18) and from 5.6 to 2.3 (p < 0.01) for patients with metatarsalgia (n = 28).ConclusionPatients treated with gastrocnemius recession for plantar fasciitis demonstrated good clinical results. The complication rate was higher than reported by others.     

Proximal Ultrasound-Guided Gastrocnemius Recession: A New Ultra-Minimally Invasive Surgical Technique

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.     

腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩

目的介绍及评价腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的手术方法及术后疗效。方法回顾性研究2006年7月至2013年7月期间,本组采用腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的患者。患者术前体检Silfverskild试验（＋）,采用Baumann入路在腓肠肌与比目鱼肌间隙之间,松解腓肠肌前方腱膜,背伸踝关节至角度满意。术前和末次随访时测量踝关节的最大被动背伸角度（膝关节伸直位和屈曲90°时）,进行美国足踝医师协会后足-踝关节（AOFAS-AH）评分,并记录术后并发症情况。结果 29例（35足）患者获得随访,平均年龄36.5岁（8~69岁）,平均随访32.6个月（7~54个月）。其中成人扁平足11例13足,儿童扁平足4例5足,踇外翻6例8足,跖筋膜炎5例6足,创伤性马蹄足3例3足。术前和末次随访时伸膝位踝关节最大被动背伸角度分别为（-5.7°±3.2°）（-15°~3°）和（8.2°±3.7°）（-6°~17°）（P〈0.01）,背伸角度平均增加13.9°。AOFAS-AH评分由术前平均46.7分提高到末次随访的75.1分（P〈0.01）。术后马蹄足畸形复发2例（2足）,无过度延长、神经血管损伤及伤口并发症发生。结论腓肠肌前方腱膜松解操作方便,术后踝关节背伸角度恢复满意,跖屈肌力良好,未见明显并发症,是治疗非痉挛性腓肠肌挛缩安全、有效的手术方法。     

Surgical anatomy of the gastrocnemius recession (Strayer procedure)

BACKGROUND: The Strayer procedure (gastrocnemius recession) is a treatment option for patients with clinically relevant gastrocnemius equinus contracture. The purpose of this study was to review the surgical anatomy of the Strayer procedure with specific reference to 1) the location of the sural nerve, and 2) the gastrocnemius tendon release point. METHODS: Forty consecutive Strayer procedures in 33 patients (15 males, 18 females) served as the study group. Recorded measurements included: 1) the location of the sural nerve relative to the deep fascia, 2) the distance from the medial border of the gastrocnemius tendon to the sural nerve, and 3) the distance from the distal end of the gastrocnemius muscle belly (identified by surface landmarks) to the actual release site. RESULTS: At the point of the gastrocnemius release, the sural nerve was located superficial to the fascia in 17/40 legs (42.5%) and deep to the fascia in 23/40 legs (57.5%). In five legs (12.5%), the nerve was directly applied to the gastrocnemius tendon and needed to be gently dissected off the tendon. The gastrocnemius release point was located an average of 18 mm distal (range, 20 mm proximal to 57 mm distal) to the surface landmark created by the distal extent of the gastrocnemius muscle belly. CONCLUSION: Knowledge of the relevant anatomy associated with the gastrocnemius recession should allow surgeons to minimize the rate of sural nerve injuries and improve cosmesis by decreasing the length of the surgical incision. A posteromedial incision that begins 2 cm distal to the gastrocnemius indentation and extends proximally will minimize the length of the incision required.     

Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review

Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.     

经胸乳入路腔镜手术治疗女性单侧甲状腺微小乳头状癌的临床价值

目的:探讨经胸乳入路腔镜技术在女性单侧甲状腺微小乳头状癌手术中的应用价值.方法:回顾分析2019年1月至2020年7月收治的50例女性甲状腺微小乳头状癌患者的临床资料,根据术式分为腔镜组(n=25)与开放组(n=25).对比分析两组手术时间、中央区淋巴结清扫数量、术后引流量、置管时间、术后美容效果、术后并发症等.结果:...     

Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m²). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1–24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.     

Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy

Preoperative and postoperative gait analysis data were retrospectively studied for 54 children with cerebral palsy who had undergone either gastrocnemius recession (GR) or tendo-achilles lengthening (TAL) as part of multi-level surgery. Decision-making between GR and TAL was based on the Silfverski?ld test. The TAL group had greater equinus preoperatively than the GR group. Both groups showed significant improvement in static and dynamic dorsiflexion and in outcome measured by a modified Physician Rating Scale (PRS) postoperatively. Calf spasticity decreased and push-off power increased after GR. Both GR and TAL are effective in appropriately selected patients. However, a potential for over- and under-correction with both GR and TAL was demonstrated.