Isolated recession of the gastrocnemius muscle: the Baumann procedure

BACKGROUND: The Baumann procedure consists of intramuscular lengthening (recession) of the gastrocnemius muscle in the deep interval between the soleus and gastrocnemius muscles. The goal of the procedure is to increase ankle dorsiflexion when ankle movement is restricted by a contracted gastrocnemius muscle. Unlike the Vulpius procedure, the Baumann procedure truly isolates the lengthening site to the gastrocnemius muscle and does not lengthen the soleus muscle. The Baumann procedure has not previously been studied in cadaver specimens. METHODS: The gastrocnemius and soleus muscles of 15 normal cadaver specimens had four sequential releases: a single gastrocnemius recession, a second gastrocnemius recession, a single soleus recession, and an Achilles tenotomy. Ankle dorsiflexion was measured with a goniometer initially, after each muscle recession, and after the tenotomy. RESULTS: After the second gastrocnemius recession, the average increase in ankle dorsiflexion measured 14 degrees with the knee extended and 8 degrees with the knee flexed. CONCLUSIONS: The Baumann procedure treats equinus contracture of the gastrocnemius muscle by improving ankle joint dorsiflexion. The procedure is indicated when the results of the Silfverski?ld test are positive.     

Macroscopic changes in sural nerve after gastrocnemius recession: a cadaver study

BackgroundGastrocnemius recession is a common foot and ankle procedure and various techniques that have been utilized are mainly delineated by the anatomic position of the gastrocnemius transection; the 2 common ones are the Baumann and Strayer procedure. Both can adversely affect the sural nerve. The objective of this study was to evaluate the macroscopic changes in the sural nerve following gastrocnemius recession, and to compare the efficacy of the two procedures, regarding the improvement of maximal ankle dorsiflexion.MethodsTen fresh-frozen, above knee cadaveric legs were assigned to one of two gastrocnemius recession techniques: Baumann (n = 5) or Strayer (n = 5). A goniometer was used to measure degree of ankle dorsiflexion before and after the surgery. The sural nerve was meticulously dissected and marked with two suture knots, 2 cm apart. The ankle was passively dorsiflexed from 90° to maximal dorsiflexion in 5° degree increments, and the distance between two suture knots was measured at each increment. The distance between the two cut ends of gastrocnemius muscle was measured with the ankle at 90° and at maximal dorsiflexion.ResultsOverall, a mean increase in length between the suture knots on the sural nerve was 0.2 cm, from 90° to maximum ankle dorsiflexion (130°); both the Baumann and Strayer techniques resulted in 0.2 cm increase. The mean improvement in maximal ankle dorsiflexion in the Baumann and Strayer group was 22.6° and 22°, respectively. The mean change in distance between the two cut ends of the gastrocnemius muscle in the Baumann and Strayer group was 1.0 cm and 0.9 cm, respectively.ConclusionIncreased dorsiflexion of the ankle following Strayer or Baumann gastrocnemius recession resulted in similar macroscopic change in the sural nerve, which may contribute to the development of sural neuritis. Further clinical studies are warranted to assess clinical implications of these findings.     

Endoscopic gastrocnemius recession: evaluation in a cadaver model

The purpose of this study was to describe a new method of gastrocnemius recession using an endoscopic approach and to determine the accuracy of incision placement during gastrocnemius recession. Fifteen fresh-frozen cadaveric limbs underwent an endoscopic gastrocnemius recession utilizing a two-portal technique. All limbs were anatomically dissected after the procedure and each was examined for injury to the sural nerve. The ability to visualize the sural nerve intraoperatively, improvement in ankle dorsiflexion, time requirement for the procedure, incision size, and appropriateness of placement to facilitate recession were recorded for each specimen. An average of 83% of the gastrocnemius aponeurosis was transected in all 15 cadavers. After modifications of the technique, the final eight cadavers were noted to have had the entire (100%) gastrocnemius aponeurosis transected. Sural nerve injury occurred in one specimen (7%) in which the aponeurosis and the sural nerve were not well visualized. The sural nerve was definitively visualized during the procedure in 5 of 15 specimens (33%). No Achilles tendon injury was noted in any specimen. There was a mean improvement in ankle dorsiflexion of 20 degrees (range, 10 degrees-30 degrees) during full knee extension. The average length of time to perform the procedure was 20 minutes (range, 10-35 minutes). The average medial and lateral incision lengths used in the two-portal technique were 18 mm (range, 14-22 mm) and 17 mm (range, 12-19 mm), respectively, and the average distance from the midpoint of the medial incision to the level of the gastrocnemius-soleus junction was 26 mm (range, 5-60 mm). These results indicate that a complete gastrocnemius aponeurosis transection may be obtained utilizing a modified endoscopic gastrocnemius recession, but visualization of the sural nerve is poor with possible risk of iatrogenic nerve injury.     

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.     

Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study

PurposeGastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk’s technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession.MethodsA cadaveric study was performed on 15 lower limb adult specimens. Isolated medial gastrocnemius head recession was initially performed, followed by an additional recession of the lateral gastrocnemius head. Ankle dorsiflexion torque was applied with 2 and 4 kg forces on second metatarsal head. Ankle dorsiflexion was measured with the knee both in extension and at 90° of flexion and values were recorded before surgery (T0), after medial head recession (T1) and after both heads recession (T2). Normality of data was assessed using the Shapiro–Wilk test, then measurements were compared in the three conditions with appropriate statistical tests.ResultsAfter isolated medial gastrocnemius recession (Δ = T1-T0), ankle dorsiflexion assessed with the knee in extension significantly increased by 5° ± 3 (range, −2 to 10) with a 2-kg torque (p = 0.02) and by 4.5° ± 3 (range, −4 to 10) with a 4-kg torque (p = 0.04). No significant difference was observed with the knee flexed at 90° (p > 0.05 for all measurements). After both gastrocnemius heads recession (Δ = T2-T1), although a further increase in dorsiflexion was noticed, statistical significance was not reached neither with the knee in extension nor at 90° of flexion (p > 0.05 for all measurements).ConclusionIn this study, isolated medial gastrocnemius head recession performed according to LS Barouk’s technique was effective in improving ankle dorsiflexion, whereas the additional release of the lateral head did not produce any significant change.Level of evidenceLevel V, cadaveric study.     

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。     

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.     

Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthening

BACKGROUND: Empirical observations of subjects with an equinus gait have suggested that there is coupled motion between the ankle and knee such that, during single-limb stance, the ankle moves into equinus as the knee extends. Since the gastrocnemius-soleus muscle-tendon unit spans both joints, we hypothesized that this muscle-tendon unit may be responsible for the coupling and that lengthening of the gastrocnemius-soleus muscle alone would result in greater ankle dorsiflexion as well as greater knee extension in single-limb stance, effectively uncoupling these joints. The concept that gastrocnemius-soleus lengthening may promote knee extension is counter to the popular notion that crouch gait may result if the hamstrings are not lengthened concomitantly. METHODS: A retrospective review identified thirty-four subjects with specific kinematic characteristics of equinus gait, and their gait was compared with that of normal children. Of the thirty-four subjects, eleven (twenty-two limbs) subsequently underwent isolated midcalf lengthening of the gastrocnemius and soleus muscles with use of a recession technique. Gait analysis including joint kinematics and joint kinetics, electromyography, and physical examination were performed to test the hypothesis. RESULTS: We found that, unlike the normal subjects, the patients with an equinus gait pattern had a positive correlation (r = 0.7) between ankle and knee motion during single-limb stance. As hypothesized, ankle plantar flexion occurred while the knee moved into extension during single-limb stance. Calculations of the lengths of the gastrocnemius-soleus muscle-tendon units showed them to be short throughout the gait cycle (p < 0.0001). After gastrocnemius-soleus recession, peak ankle dorsiflexion (p < 0.001) and peak ankle power (p < 0.001) shifted to occur later in stance than they did in the preoperative gait cycle. Furthermore, the magnitude of peak power increased (p < 0.001) in late stance despite the added length of the gastrocnemius-soleus muscle-tendon unit. The electromyographic amplitude of the gastrocnemius-soleus was reduced during loading (p < 0.02), and this finding, together with the kinetic changes, suggested that muscle tension was reduced. Changes at the knee were less pronounced but included greater knee extension at foot contact (p < 0.01). No increase in the knee flexion angle or extension moment occurred in midstance after the surgery. CONCLUSIONS: Patients with an equinus gait pattern function with a shortened gastrocnemius-soleus muscle-tendon unit, and this results in coupled motion between the ankle and knee during single-limb stance. Lengthening, with use of a recession technique, shifted ankle power generation and dorsiflexion to a later time in stance with no tendency to increase midstance knee flexion. Knee extension did increase at foot contact, but excessive midstance knee flexion persisted and was likely due to concomitant contracture of the hamstrings.     

The effect on ankle dorsiflexion of gastrocnemius recession

Gastrocnemius equinus contracture has been suggested as an etiologic factor in mechanical diseases of the foot and ankle and in ulcer formation in the foot. The purpose of this study is to assess the correction in ankle dorsiflexion that can be achieved with a gastrocnemius recession. An isolated gastrocnemius release (Strayer procedure) was performed on 26 legs, in 20 consecutive patients, for clinically significant gastrocnemius equinus contracture. Ankle dorsiflexion was assessed using a validated electrogoniometer. Ankle dorsiflexion was recorded with the knee straight and with the knee bent. Measurements were recorded preoperatively, and immediately postoperatively. Measurements at an average of 55.0 days postsurgery (range, 37 to 128 days) were performed on 20 legs (15 patients). RESULTS: Average preoperative ankle dorsiflexion with the knee straight was 5.1 degrees. Average preoperative ankle dorsiflexion with the knee bent was 22.8 degrees. Immediately following surgery the average ankle dorsiflexion with the knee straight was 23.2 degrees. The average correction was 18.1 degrees and this increase was significant (p < 0.0001.) In the 15 patients (20 legs) available for follow-up, the increase in ankle dorsiflexion with the knee straight was maintained (average: 24.9 degrees). Patients with gastrocnemius contracture who underwent an isolated gastrocnemius release increased their ankle dorsiflexion (knee straight) by an average of 18.1 degrees with postoperative ankle dorsiflexion (knee straight) being equivalent (23.2 and 22.8 degrees) to preoperative ankle dorsiflexion (knee bent). This correction appears to be maintained (23.2 vs. 24.9 degrees) at short-term follow-up.     

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.     

The sural artery perforator flap for coverage of defects of the knee and tibia

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

The sural artery perforator flap for coverage of defects of the knee and tibia.

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

The effect of lengthening the gastrocnemius muscle in chronic therapy resistant plantar fasciitis

BackgroundThe aetiology of chronic therapy resistant plantar fasciitis (CTRPF) is multifactorial with more focus in recent times on the gastroc-soleus complex. This study evaluates the effect of lengthening the gastrocnemius muscle in CTRPF.MethodsAll patients with CRTPF complaints for at least one year underwent the same standard conservative treatment prior to surgery. 32 patients failed this treatment and underwent gastrocnemius recession. Silfverskiöld test, questionnaires and plantar pressure measurements were obtained at 5 visits.ResultsOne year follow up showed a significantly increase in dorsiflexion of the ankle (16 degrees), a decrease in VAS; 78 (SD: 19) to 20 (SD: 24) and significant improved functional scores. Plantar pressure measurements showed an increase of pressure under the medial proximal part of the midfoot and the 1 st metatarsal and a decrease under the hallux.ConclusionsA gastrocnemius recession results in a significant gain in dorsiflexion, altered loading of the foot and good clinical outcome in patients with CTRPF.Level of EvidenceLevel 2     

Pedicled chimeric gastrocnemius—medial sural artery adipofascial flap for reconstruction of anterolateral defects of the knee

A medial gastrocnemius muscle flap is useful for soft tissue reconstruction of the knee and proximal tibia but insufficient to cover defects involving the lateral aspect of the knee. The purpose of this report is to present the results of the use of a pedicled chimeric gastrocnemius—medial sural artery adipofascial flap for reconstruction of defects of the knee and lateral aspect of the knee. Six patients underwent soft tissue reconstruction of the knee by means of the described procedure. Patients included one female and five males. The mean age of the patients was 48 years. The cause of soft tissue defects was open fractures in three cases and infection in three cases. The mean size of soft tissue defects was 9.3 × 7 cm (range: 6 × 3 to 18 × 14 cm), and the mean size of adipofascial components was 6.8 × 3.8 cm (range: 6 × 3 to 10 × 6 cm). Medial knee defects were covered by the medial gastrocnemius muscle component and lateral knee defects were covered by the medial sural artery adipofascial component. All flaps survived in the six cases. Soft tissue reconstruction and infection control were successful without any additional surgical procedures. A pedicled chimeric gastrocnemius–medial sural artery adipofascial flap may be considered effective for soft tissue reconstruction of the knee as it reduces scars at the donor site and reconstructs the lateral knee defects not covered by the medial gastrocnemius muscle flap. © 2015 Wiley Periodicals, Inc. Microsurgery 37:206–211, 2017.     

Muscle strength and knee range of motion after femoral lengthening

Background and purpose — Femoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength.

Patients and methods — This prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years.

Results — Mean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7?Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up.

Interpretation — Most variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion.     

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.     

Innervation of calf muscles in relation to calf reduction

Plump and muscular calves, a so-called radish-like leg, embarrass young women and cause a feeling of inferiority in Korea. Damage to motor nerves innervating a muscle makes the muscle paralyzed and dystrophic, with loss of muscle volume. The authors studied the morphometry of the motor branches of the tibial nerve innervating the gastrocnemius and soleus muscle and sensory medial sural cutaneous nerve in popliteal fossa. Dissection and exploration of the tibial nerve were performed in the popliteal fossae of 70 legs (of 18 males and 17 females) of embalmed Korean cadavers. The main branch of the tibial nerve innervating medial and lateral gastrocnemius muscle originated 3 cm above and below the popliteal crease. The medial gastrocnemius muscle had an additional nerve (49%). The medial sural cutaneous nerve came off the nerve into the medial gastrocnemius muscle (30%) and diverged 5.5 mm from the tibial nerve. The nerve into the soleus muscle originated from the nerve innervating the lateral gastrocnemius muscle (30%) and was 12.3 mm away from it. Surgeons should keep in mind that the medial sural cutaneous nerve originates from the nerve to medial gastrocnemius in 30% and the nerve to soleus muscle originates from the nerve to lateral gastrocnemius in 30%.     

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.     

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。     

Soleus and gastrocnemius muscle loading decreases anterior tibial translation in anterior cruciate ligament intact and deficient knees

This study evaluated the effect of the gastrocnemius and soleus muscles on dynamic knee stability by studying the effect of passive calf muscle loading on anterior tibial translation in normal and anterior cruciate ligament (ACL) deficient knees. Anterior tibial translation was measured bilaterally in 12 anesthetized patients with unilateral ACL-deficient knees using a KT-1000 arthrometer. An ankle-foot orthosis was used to passively dorsiflex the ankle and generate tension in the calf muscles. As the ankle flexion angle was progressively changed from 30 degrees plantar flexion to 10 degrees dorsiflexion, anterior tibial translation decreased 43% and 37% with manual maximum force in normal and ACL-deficient knees, respectively (P < .0001). These findings suggest that the calf muscles may function as dynamic knee stabilizers. Anterior tibial translation also was measured in four cadaver knees. Significant decreases were seen in anterior tibial translation with progressive ankle dorsiflexion in ACL-intact specimens and after the ACL had been cut (P < .05). This effect persisted when the gastrocnemius muscle was cut, but was lost when the soleus muscle was released. The data suggest that the soleus muscle may play a role in dynamically stabilizing the knee.