Endoscopic Gastrocnemius Recession: Evaluation in a Cadaver Model

2003 ◽  
Vol 24 (8) ◽  
pp. 607-613 ◽  
Author(s):  
Robert Z. Tashjian ◽  
A. Joshua Appel ◽  
Rahul Banerjee ◽  
Christopher W. DiGiovanni
Keyword(s):  
Nerve Injury ◽  
Sural Nerve ◽  
Average Length ◽  
Average Distance ◽  
Knee Extension ◽  
Ankle Dorsiflexion ◽  
Lateral Incision ◽  
Incision Size ◽  
Gastrocnemius Recession ◽  
Portal Technique

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° (range, 10°–30°) 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.

Anatomic Study of the Gastrocnemius–Soleus Junction and its Relationship to the Sural Nerve

2003 ◽  
Vol 24 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Robert Z. Tashjian ◽  
A. Joshua Appel ◽  
Rahul Banerjee ◽  
Christopher W. DiGiovanni
Keyword(s):  
Sural Nerve ◽  
Average Distance ◽  
Average Width ◽  
Musculotendinous Junction ◽  
Lateral Border ◽  
Adjunct Treatment ◽  
Average Percentage ◽  
Vertical Extension ◽  
Fresh Frozen ◽  
Gastrocnemius Recession

Background: Gastrocnemius recession is performed for equinus contracture of the ankle and as an adjunct treatment for various foot pathologies. Successful release relies on many factors, including a thorough knowledge of the anatomy of the gastrocnemius-soleus junction and its relationship to the sural nerve which may be vulnerable to iatrogenic injury. Neither the average width of the tendon at the gastrocnemius-soleus junction, the anatomy of the sural nerve with respect to the gastrocnemius-soleus junction, nor appropriate landmarks for accurate incision placement at this level to avoid undesirable vertical extension, however, have yet to be acceptably defined. Methods: Fourteen fresh-frozen cadavers were dissected and the width of the tendon at the gastrocnemius-soleus junction, the distance of the sural nerve from the lateral border of the tendon at this level, the length of the fibula, and the distance from the distal tip of the fibula to the gastrocnemius-soleus junction were measured. Results: The average width of the gastrocnemius-soleus complex at the junction was 58 mm (range, 44–69 mm), the average distance of the sural nerve from the lateral border of the gastrocnemius-soleus complex at the level of the gastrocnemius-soleus junction was 12 mm (range, 7–17 mm), the average percentage of this distance as compared to the entire width of gastrocnemius-soleus junction was 20% (range, 13%-27%), and the ratio of the distance of the gastrocnemius-soleus junction from the distal tip of the fibula divided by the length of the fibula was 0.5 (range, 0.5–0.6). Conclusion: These results provide some guidelines as to the approximate size of the gastrocnemius–soleus complex at the site of gastrocnemius recession along with the location of the sural nerve at the musculotendinous junction. Also, the results indicate that the fibula can serve as a reproducible anatomic landmark to enable localization of the gastrocnemius–soleus junction at the time of gastrocnemius recession.

Outcomes and Incidence of Complications Following Endoscopic Gastrocnemius Recession: A Systematic Review

2020 ◽  
pp. 193864001989276 ◽  
Author(s):  
Roberto A. Brandão ◽  
Eric So ◽  
James Steriovski ◽  
Christopher F. Hyer ◽  
Mark A. Prissel
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Nerve Injury ◽  
Complication Rate ◽  
Sural Nerve ◽  
Endoscopic Approach ◽  
Wound Complications ◽  
Weighted Mean ◽  
Gastrocnemius Recession ◽  
Equinus Contracture

Introduction: Equinus contracture of the ankle can lead to a multitude of foot and ankle pathologies. The gastrocnemius recession has been used to address equinus deformity via various methods, including either an open or an endoscopic approach. Open techniques require increased intraoperative time and complication risks of sural nerve injury, wound complications, and poor cosmesis. Resultantly, the aim of the current study is to review the complications and outcomes of the endoscopic gastrocnemius recession. Methods: A systematic review of electronic databases was performed. The authors compiled data from retrospective and prospective patient studies including general patient demographics, outcomes, qualitative scoring measures, complications, and surgical technique. Results: Eleven studies met our inclusion criteria. A total of 697 feet in 627 patients were included in the current systematic review. The weighted mean age was 45.3 years and weighted mean follow-up was 18.4 months. The most common indication for an endoscopic gastrocnemius recession was equinus contracture. The weighted mean preoperative ankle range of motion was −2.3° and the weighted postoperative ankle range of motion was 10.9°. The most common complications included plantarflexion weakness of the ankle at 3.5%, a sural nerve injury of 3.0% and wound complication rate was 1.0% with no deep infection. The overall complication rate was 7.5%. Conclusion: The endoscopic gastrocnemius recession is a valuable surgical tool in the treatment of ankle equinus. The endoscopic approach has satisfactory outcomes including low incidence of plantarflexion weakness and sural neuritis. Patients should be counseled on these risks preoperatively. Compared with previously reported systematic review of the open technique, the endoscopic approach has a lower overall incidence of complications. Prospective clinical trials comparing open and endoscopic techniques are warranted. Levels of Evidence: Level IV

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

The Foot ◽  
2021 ◽  
pp. 101842
Author(s):  
Giovanni Manzi ◽  
Alessio Bernasconi ◽  
Julien Lopez ◽  
Jean Brilhault
Keyword(s):  
Ankle Dorsiflexion ◽  
Cadaveric Study ◽  
Gastrocnemius Recession

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

Anatomy of the sural nerve and its relation to the Achilles Tendon

2000 ◽  
Vol 21 (6) ◽  
pp. 475-477 ◽  
Author(s):  
Jonathan Webb ◽  
Narain Moorjani ◽  
Mike Radford
Keyword(s):  
Achilles Tendon ◽  
Nerve Injury ◽  
Individual Variation ◽  
Sural Nerve ◽  
Proximal Part ◽  
Lower Limbs ◽  
Lateral Border

Sural nerve injury is a complication of Achilles Tendon (TA) rupture. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the TA. At the level of insertion of the TA into the calcaneum, the sural nerve was a mean 18.8 mm from the lateral border of the TA. The proximal course of the nerve was towards the midline such that it crossed the lateral border of the TA at a mean distance of 9.8 cm from the calcaneum. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Percutaneous sutures should not be placed in the lateral half of the TA.

scholarly journals Can sural nerve injury be avoided in the sinus tarsi approach for calcaneal fracture?

Medicine ◽  
2019 ◽  
Vol 98 (42) ◽  
pp. e17611 ◽  
Author(s):  
Jeong-Hyun Park ◽  
Dong-Il Chun ◽  
Kwang-Rak Park ◽  
Gun-Hyun Park ◽  
Suyeon Park ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Sural Nerve ◽  
Calcaneal Fracture ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Risk of Sural Nerve Injury with Intramedullary Screw Fixation of Fifth Metatarsal Fractures: A Cadaver Study

1999 ◽  
Vol 20 (3) ◽  
pp. 182-184 ◽  
Author(s):  
Brian G. Donley ◽  
Michael J. McCollum ◽  
G. Andrew Murphy ◽  
E. Greer Richardson
Keyword(s):  
Nerve Injury ◽  
Sural Nerve ◽  
Screw Fixation ◽  
Cadaver Study ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

scholarly journals Sural nerve injury after repair of a ruptured Achilles tendon: Case report and literature review

2014 ◽  
Vol 57 ◽  
pp. e277
Author(s):  
B. De Fontenellle ◽  
J.M. Coudreuse ◽  
L. Bensoussan ◽  
J.M. Viton ◽  
A. Delarque
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve

A MATHEMATICAL TREATMENT OF A THEORY OF RUBBER STRUCTURE

1934 ◽  
Vol 10 (5) ◽  
pp. 486-520 ◽  
Author(s):  
T. R. Griffith
Keyword(s):  
Average Length ◽  
Average Distance ◽  
Strain Curve ◽  
Molecular Chain ◽  
Mathematical Work ◽  
Mathematical Treatment ◽  
Stress Strain Curve ◽  
Stress Strain ◽  
Starting Point ◽  
Junction Points

The theory that the elasticity of rubber is due to the heat vibrations of very long chain molecules, bound to one another at occasional points along their length, but able to move freely relatively to one another at all other points, is susceptible of mathematical treatment. In the present treatment it is assumed that the rubber molecule has a restricted rotation about the axis formed by joining two adjacent junction points.A stress-strain curve has been developed mathematically on this assumption, and this curve, which is a reasonably close approximation to the curve obtained experimentally, serves as a standard with which to compare the rubber stress-strain curve and as a starting point for further mathematical work on the structure of rubber. The discrepancy between the mathematical and the experimental curve is explained on the very probable assumption that there is a wave motion or other vibration along the length of the rotating chain, as well as a rotation of the chain as a whole.An explanation of the peculiar S-shape of the beginning of the experimental stress-strain curve develops automatically from the mathematically deduced relation between stress and strain, and it is also shown why the S-shape appears to vanish when the calculation of the stress is based on the actual cross section of the stretched rubber.In addition, the following values, calculated from the above assumption and X-ray data, of certain constants, were obtained:(i) The average distance between junction points.(ii) The average length of molecular chain between junction points and, incidentally, the ratio between the number of freely swinging carbon atoms and those bound at junction points. This gives the number of freely swinging carbon atoms on the molecular chain between junction points and an idea of the length of the rubber molecule.(iii) The quantity of kinetic energy per cubic centimetre causing the elastic effect in rubber.(iv) The percentage of sulphur necessary to form the junction points in vulcanized rubber and, consequently, the minimum quantity of sulphur needed for vulcanization, both for hard and soft rubber. This minimum agrees closely with practical experiment.

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