SLR - May 2022 - Taylor Tendrich, DPM
Reference: Kow, R. Y., Che-Ahmad, A., Ayeop, M. A., Ahmad, M. W., & Yusof, S. (2021). A Novel Technique of Isolated Gastrocnemius Recession: A Cadaveric Comparison with Strayer Procedure. Journal of Orthopaedic Surgery, 29(3), 230949902110439. https://doi.org/10.1177/23094990211043987Level of Evidence: II
Scientific Literature Review
Reviewed By: Taylor R. Tendrich, DPM
Residency Program: Northwest Medical Center – Margate, FL
Podiatric Relevance: Equinus is a common deformity in lower extremity pathology and the treatment of this deformity has different methods. The Strayer gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Surgical treatment should be patient specific based on the underlying pathology to obtain the best functional outcome. Gastrocnemius recessions can be performed by an open or endoscopic technique. Some flaws of the gastrocnemius recession are sural nerve injury or saphenous vein injury. The purpose of this study was 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 were used in this study. All eight cadavers were tested of their gastrocnemius tightness by isolated traction of the gastrocnemius muscles. A gastrocnemius recession was performed on all eight models with the Strayer method and the novel method randomized equally. The novel technique consisted of separating the gastrocnemius from the soleus at the knee region. The medial and lateral heads of the gastrocnemius were sutured continuously to ensure the pulling force would be even along the muscle bellies. Three thick threads were then anchored to the medial, lateral, and medial/lateral heads of the gastrocnemius. The ends of the threads were tired to the base. Finally, the threads were then pulled until ankle equinus of 20 degrees was achieved. The safety aspect of both of the techniques was evaluated by identifying any nerve or vein injury to the surrounding structures. Once the maximum dorsiflexion force of 10 kilograms or the maximum dorsiflexion of 20 degrees was achieved, the lengthening distance of the gastrocnemius muscle and the dorsiflexion improvement angle were documented.
Results: In both techniques of the gastrocnemius recession, a mini open approach was performed. The sural nerve was carefully avoided by using blunt dissection and subcutaneous tissue retraction after performing the skin incision. In some cases, the sural nerve was not identified and in others it was visualized. 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 and improvement of ankle dorsiflexion
Conclusions: In conclusion, this cadaveric biomechanical study of the novel technique of gastrocnemius recession shows that it is safe and effective in the treatment of conditions associated with isolated gastrocnemius tightness. This is important in podiatric medicine because one the main complications of gastrocnemius recession is sural nerve injury. Injury to the sural nerve is possible in the Strayer procedure due to the transverse incision made for gastrocnemius recession. This new technique can reduce the risk of sural nerve injury by performing two oblique incisions instead of the transverse incision, sparing the area between the two heads of gastrocnemius where the sural nerve is commonly located. When considering procedures for the gastrocnemius recession in future patients, this novel new technique should be considered.