SLR - May 2015 - Satwinder Kaur Gosal

Isolated Gastrocnemius Recession for Achilles Tendinopathy: Strength and Functional Outcomes

Reference:  Nawoczenski DA, Barske H, Tome J, Dawson LK,  Zlotnicki JP, DiGiovanni BF. Isolated Gastrocnemius Recession for Achilles Tendinopathy: Strength and Functional Outcomes. J Bone Joint Surg Am. 2015 Jan 21;97(2):99-105.
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Reviewed By: Satwinder Kaur Gosal, DPM
Residency Program: Massachusetts General Hospital, Boston, MA

Podiatric Relevance: Achilles tendinopathy is a common foot and ankle disorder which impacts the activities of daily living and can result in diminished quality of life. Cumulative microtrauma due to mechanical overload is thought to be the primary etiology of Achilles tendinopathy. It has been proposed that a gastrocnemius recession can reduce load on the Achilles tendon without the loss of strength that may be associated with traditional Achilles tendon surgical procedures. This article aims to evaluate the strength and functional outcomes of such procedure.

Methods: Thirteen patients with unilateral Achilles tendinopathy who underwent gastrocnemius recession and ten control subjects matched for age and body mass index were included in this study. Pain measured with use of 10-cm numeric pain rating visual analog scale (VAS). The Foot and Ankle Ability Measure (FAAM) was used to assess reported level of function. Isokinetic concentric ankle plantar flexion strength was assessed at 60?/sec and 120?/sec to evaluate angular velocities which are thought to simulate daily activities such as stair climbing and gait. Statistical analysis consisted of creating 95 percent confidence intervals for the FAAM from the database of healthy subjects to establish a normative range for activities of daily living and sports subscales and paired t tests to evaluate the side to side differences of limb strength and symmetry.

Results: Mean duration of follow up was eighteen months. Ten patients had insertional tendinopathy and three patients had noninsertional tendinopathy. Dorsiflexion was greater in the involved limb than uninvolved limb of Achilles tendinopathy, 17.6? and 13.3?; p>0.05. Mean VAS pain score was 6.8 preoperatively and 1.6 postoperatively. FAAM outcomes showed a significant difference between groups, in activities of daily living (tendinopathy group 89.7; control group 98.5, p < 0.05) and sports (tendinopathy group 71.9; control 95.1, p < 0.05). The majority of the tendinopathy group approached the lower bounds of 95 percent confidence interval of the control subjects in regard to activities of daily living. Nine of the thirteen tendinopathy subjects were satisfied with the results. The Achilles tendinopathy group showed significant side to side differences compared to the control group.  There were no noted differences in peak torque values for involved limbs of tendinopathy and nondominant limb of the control group at 60?/sec and 120?/sec.

Conclusion: Isolated gastrocnemius recession is an option for pain relief associated with isolated contracture of the gastrocnemius muscle in patients with chronic Achilles tendinopathy who have failed nonoperative treatments. Adequate function in activities of daily living can be expected; however a deficit may be noted while participating in sports requiring push off function such as running, jumping, starting and stopping quickly, and lateral movements. 

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