Isolated Gastrocnemius Recession for the Treatment of Achilles Tendinopathy

2017 ◽  
Vol 11 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Kenneth S. Smith ◽  
Caleb Jones ◽  
Zachariah Pinter ◽  
Ashish Shah
Keyword(s):  
Achilles Tendinopathy ◽  
Treatment Modalities ◽  
Gastrocnemius Recession ◽  
Foot Function ◽  
Vas Scores ◽  
Average Body Mass ◽  
Equinus Contracture ◽  
Student’S T ◽  
Average Body

Background: Various treatment modalities have been described for Achilles tendinopathy with varying degrees of success. The rationale for the gastrocnemius recession procedure is to decrease the mechanical overload of the Achilles tendon arising from an equinus contracture. Methods: We retrospectively reviewed 25 patients who underwent an isolated gastrocnemius recession procedure at our institution between May 2013 and April 2015 by a single surgeon. Clinical outcome was evaluated on the basis of pain, utilizing visual analog scale (VAS) scores and the Foot Function Index (FFI) by telephonic interview. Student’s t test and one-way analysis of variance were used for statistical analysis. Results: The average age of patients was 53.2 years with an average body mass index of 35.8 kg/m2. The average follow-up was 13.1 months. All 25 patients had a decrease in VAS scores from an average of 8.9 preoperatively to 2.0 at the 6-week visit. The average FFI went from 73.5 preoperatively to 27.4 at final follow-up. Two out of 25 patients had a postoperative sural neuritis with a total complication rate of 12%. Twenty-one of 25 patients (84%) reported total or significant pain relief. Conclusion: The medium-term results of our study suggest that an isolated gastrocnemius recession is a simple, effective, and safe surgical procedure for the treatment of Achilles tendinopathy. Levels of Evidence: Therapeutic, Level IV: Retrospective

scholarly journals Gastrocnemius Recession to Treat Chronic Insertional and Noninsertional Achilles Tendinopathy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Robert Graham ◽  
Collin Innis ◽  
Benjamin Stevens
Keyword(s):  
Patient Satisfaction ◽  
Achilles Tendinopathy ◽  
Foot Deformities ◽  
Preoperative Pain ◽  
Patient Satisfaction Questionnaire ◽  
Gastrocnemius Recession ◽  
Equinus Contracture ◽  
Time Required ◽  
Chronic Achilles Tendinopathy

Category: Hindfoot Introduction/Purpose: Small studies on gastrocnemius recession for Achilles tendinopathy with associated contracture of the gastrocnemius muscle are encouraging. The analyses have demonstrated fewer postoperative complications, shortened recovery time, and earlier return to work as compared to traditional surgical management of Achilles debridement and repair. Investigators have reported good patient satisfaction, substantial pain reduction, and restoration of dorsiflexion. However, there have been no large studies specifically looking at the outcomes of gastrocnemius recession for either chronic insertional or noninsertional Achilles tendinopathy. The purpose of this study was to review the efficacy of the gastrocnemius recession in mitigating pain for patients who have chronic Achilles tendinopathy with isolated gastrocnemius contracture and have failed nonoperative management. Methods: The records of patients with isolated gastrocnemius contracture were retrospectively reviewed who underwent an isolated gastrocnemius recession to treat insertional or noninsertional Achilles tendinopathy as performed by a single surgeon spanning from 2011 to 2017. Minimum follow-up time required was 6 months with an average of 25.5 months follow-up among all responders with a range from 6 to 63 months. Patients were excluded by the criteria of any other concomitant foot deformities, diagnoses, or surgical procedures performed. Clinical outcome was evaluated using a mail-in patient satisfaction questionnaire. One hundred and thirty-nine patients were identified to have underwent an isolated gastrocnemius recession to treat chronic insertional or noninsertional Achilles tendinopathy that was refractory to conservative management for a minimum of six months. Sixty-six patients (76 legs) of those eligible responded. Results: Sixty-three out of 66 patients (95.5%) were satisfied with the results of the procedure overall. Sixty-two out of 66 patients (93.9%) would elect to repeat the surgery if they knew their results in advance. Sixty-one out of 66 patients (92.4%) would recommend the surgery to a family or friend with the same diagnosis. The most frequently reported postoperative complication was 9 accounts of swelling (out of 76 legs; 11.8%). There were no reports of sural nerve injury. Responses for Visual Analogue scale (VAS) for pain were only eligible if they had reported a preoperative VAS score on their preoperative intake form. This made 23 patients eligible with an average preoperative pain of 8.43/10 and an average postoperative pain of 0.91/10. Conclusion: Gastrocnemius recession for treating chronic Achilles tendinopathy was found to be an effective procedure to mitigate pain in patients with isolated equinus contracture. To our knowledge, this is the largest study assessing gastrocnemius recession for treatment of chronic Achilles tendinopathy.

scholarly journals Outcomes of Gastrocnemius Recession in Patients with Plantar Fasciitis and Achilles Tendinosis: A Retrospective Study of 160 Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0046
Author(s):  
Wesley Stroud ◽  
Bradley Alexander ◽  
Jared R. Halstrom ◽  
Hannah M. Barranco ◽  
Benjamin B. Cage ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Physical Function ◽  
Patient Outcomes ◽  
Plantar Fasciitis ◽  
Preoperative Diagnosis ◽  
Achilles Tendinopathy ◽  
Achilles Tendinosis ◽  
Gastrocnemius Recession ◽  
Vas Scores

Category: Hindfoot Introduction/Purpose: Plantar fasciitis and achilles tendonopathy are two of the most common foot and ankle overuse conditions encountered in clinical practice. Several recent studies have shown isolated gastrocnemius recession to be a viable treatment option for these conditions when conservative management has failed. Patient outcomes have primarily been assessed through pain and functionality scores. While pain improvement and motion restoration are of utmost importance, plantar flexion power and endurance are also key to patients’ ability to return to everyday activities. Here, we assess patient outcome scores of individuals that underwent gastrocnemius recession for plantar fascitis and achilles tendonopathy to see if surgery was beneficial. Methods: We reviewed 160 patients who underwent isolated gastrocnemius recession for chronic plantar fasciitis and achilles tendinopathy by a single surgeon from June 2011 to August 2018. Data was collected regarding patient pre-operative and post- operative pain scores at 3 months, 1 year, and final follow-up, and post-operative PROMIS physical function (PF), pain interference (PI), and depression (D) t-scores at final follow-up. We also collected data regarding time to full weight bearing, time to 50% and 100% pain relief, time to return to work, time to return to ADL, and time for patient to be out of boot. The patient population was then stratified by preoperative diagnosis and if patients received formal physical therapy. The cohorts consisted of patients that had plantar fasciitis, Achilles tendinosis, or a combination of both. The other cohorts were patients that received formal physical therapy and those that did not receive physical therapy. Results: The average preopeartive VAS score fot plantar fasciitis Achilles tendinosis and a combination of both was 4.27 4.10 and 4.93 respectively. For patients that had 3 month follow up (96) all three cohorts saw a decrease in VAS scores at 3 months (1.98, 1.50, and 1.80 respectively). Patients who received physical therapy saw a larger decrease in VAS scores (2.05 vs 1.03 respectively). Patients in all three groups were able to be fully weight baring within 30 days. 20.27 days in the plantar fasciitis, 19.25 for Achilles tendinopathy, and 28.3 days in the combination cohort. Patients with Achillis tendinosis had were able to get out of their boot the fastest (29.75 days). PROMIS scores were similar across all cohorts. Conclusion: This study is the first to complete a through evaluation of patient outcomes after gastrocnemius recession. Additionally, the study is one of the largest cohorts. This study helps to confirm that the surgery is beneficial for both plantar fasciitis and achilles tendinosis. In all cohorts patients pain improved with surgical intervention despite preoperative diagnosis and physical therapy status. Additionally, PROMIS scores across all of the patients were similar and did not indicate any signifcant decreases in physical function or increases in pain. [Table: see text]

scholarly journals Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Reem EL-Mallah ◽  
Enas A. Elattar
Keyword(s):  
Treatment Options ◽  
Visual Analogue Score ◽  
Achilles Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Tendon Thickness ◽  
Vas Scores ◽  
Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

scholarly journals Prospective Analysis of Isolated Gastrocnemius Recession for Achilles Tendinopathy; Intermediate Follow-up

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0025
Author(s):  
Benjamin M. Weisenthal ◽  
Deborah A. Nawoczenski ◽  
Benedict F. DiGiovanni ◽  
Josh Tome ◽  
Frank E. DiLiberto
Keyword(s):  
Achilles Tendinopathy ◽  
Prospective Analysis ◽  
Gastrocnemius Recession

scholarly journals Cartilage Surgery in Overweight Patients: Clinical and MRI Results after the Autologous Matrix-Induced Chondrogenesis Procedure

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Matthias Lahner ◽  
Christopher Ull ◽  
Marco Hagen ◽  
Christoph von Schulze Pellengahr ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Lesion Size ◽  
Single Step ◽  
Lysholm Score ◽  
Cartilage Defects ◽  
Knee Cartilage ◽  
Average Body Mass Index ◽  
Average Body Mass ◽  
Average Body

Modern orthopaedic surgery provides a variety of techniques for cartilage repair. The Autologous Matrix-Induced Chondrogenesis (AMIC) procedure is a single-step technique with a collagen I/III scaffold for the treatment of full-thickness cartilage lesions. The aim of the study was to analyze the outcome of the AMIC procedure in overweight patients with knee cartilage defects. Overweight patients treated with AMIC surgery were followed up by clinical and MRI examination. 9 patients with a cartilage defect of the knee with a mean lesion size of 2.1±1.2 cm2 and an average body mass index (BMI) of 29.3 were available for the follow-up. The Lysholm Score was significantly improved by the AMIC procedure (38 to 67, p≤0.008). The VAS Score was significantly lower after the procedure (9 to 3, p≤0.018). In the postoperative MOCART Scale, the scaffold reached defect covering of 80%. However, 2 patients had to be revised due to persisting knee pain. The AMIC procedure enhances pain reduction and gain of knee function for cartilage defects of overweight patients. However, in cases of an increased BMI, the patient had to be informed that success rate is reduced despite good defect covering.

scholarly journals Outcomes of Flexor Digitorum Longus (FDL) Tendon Transfer for the Treatment of Chronic Achilles Tendinopathy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cesar de Cesar Netto ◽  
Apisan Chinanuvathana ◽  
Lucas Furtado Da Fonseca ◽  
Andres O’Daly Baquero ◽  
Eric Tan ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Visual Analogue Score ◽  
Achilles Tendinopathy ◽  
Flexor Digitorum Longus ◽  
Functional Scale ◽  
Sf 36 ◽  
Foot Function ◽  
Flexor Digitorum ◽  
Chronic Achilles Tendinopathy

Category: Hindfoot, Sports Introduction/Purpose: Flexor hallucis longus (FHL) tendon transfer is a common surgical technique used for augmentation during the surgical treatment of chronic Achilles tendinopathy and reconstruction. Flexor digitorum longus (FDL) tendon transfer represents a viable surgical alternative for patients with failed FHL transfers or athletes where compromise of the hallux push off strength could negatively impact their level of activity. There is no reported clinical outcome data about this technique in the current literature. Our study describes the clinical and functional results after FDL tendon transfer for the treatment of patients with chronic Achilles tendinopathy. Methods: We retrospectively assessed prospectively collected data on patients that underwent FDL tendon transfer in the treatment of chronic Achilles tendinopathy (March 2012 - March 2015). Charts were reviewed for clinical data, associated treatments and complications. Preoperative assessment included the Visual Analogue Score (VAS), SF-36 health status survey and the lower extremity functional scale (LEFS). At final follow up we evaluated pain level, range of motion of the ankle and the toes, ability to perform single leg raise and toe walking, calf atrophy and complications. Postoperative outcomes were assessed by Visual Analogue Score (VAS), SF-36 health survey, Lower Extremity Functional Scale (LEFS), Foot Function Index (FFI), VISA-A score and the Foot and Ankle Ability Measure (FAAM). Fifteen patients (seventeen feet), 6 males and 9 females, mean age of 53.6 years (27- 76 years) and an average body mass index of 31.4 kg/m2 (20.5 to 45.4 kg/m2) were included in the study. Results: Mean follow-up was 27.5 months (15-49). Four patients (6 feet) had prior surgeries, including two patients with failed FHL transfer. We found significant clinical improvement when comparing pre-operative and postoperative VAS scores (6.0±3.3 versus 1±1.36; p<0.001), SF-36 physical component summary (28.2±10.7 versus 45.0±11.1; p<0.002) and LEFS (36.4±22 versus 57.9±20.5; p<0.011). At final follow up, 6/7 patients (86%) returned to prior levels of recreational sport activities. No differences were found on single leg raise test when compared to uninvolved side. One patient reported weakness for plantar flexion of the toes, without gait complaints. Mean VISA-A was 52.6 points (15-85), Foot Function Index (FFI) 21.2% (0-65%) and FAAM 86.2% (55.3-100%) for the FAAM. Three patients had superficial infection and two patients had deep infection, requiring surgical debridement. Conclusion: FDL tendon transfer represents a safe surgical alternative as a method of augmentation during the treatment of chronic Achilles tendinopathy. Our study showed comparable clinical and functional outcomes to FHL tendon transfer and minimal complications or donor site morbidity.

Weight and weight change and risk of atrial fibrillation: the HUNT study

2019 ◽  
Vol 40 (34) ◽  
pp. 2859-2866 ◽  
Author(s):  
Tingting Feng ◽  
Malmo Vegard ◽  
Linn B Strand ◽  
Lars E Laugsand ◽  
Bjørn Mørkedal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Weight Change ◽  
Normal Weight ◽  
Hazard Ratios ◽  
Hunt Study ◽  
Average Body Mass ◽  
Average Body ◽  
Over Time

Abstract Aims Although obesity has been associated with risk of atrial fibrillation (AF), the associations of long-term obesity, recent obesity, and weight change with AF risk throughout adulthood are uncertain. Methods and results An ambispective cohort study was conducted which included 15 214 individuals. The cohort was created from 2006 to 2008 (the baseline) and was followed for incident AF until 2015. Weight and height were directly measured at baseline. Data on previous weight and height were retrieved retrospectively from measurements conducted 10, 20, and 40 years prior to baseline. Average body mass index (BMI) over time and weight change was calculated. During follow-up, 1149 participants developed AF. The multivariable-adjusted hazard ratios were 1.2 (95% confidence interval 1.0–1.4) for average BMI 25.0–29.9 kg/m2 and 1.6 (1.2–2.0) for average BMI ≥30 kg/m2 when compared with normal weight. The association of average BMI with AF risk was only slightly attenuated after adjustment for most recent BMI. In contrast, current BMI was not strongly associated with the risk of AF after adjustment for average BMI earlier in life. Compared with stable BMI, both loss and gain in BMI were associated with increased AF risk. After adjustment for most recent BMI, the association of BMI gain with AF risk was largely unchanged, while the association of BMI loss with AF risk was weakened. Conclusion Long-term obesity and BMI change are associated with AF risk. Obesity earlier in life and weight gain over time exert cumulative effects on AF development even after accounting for most recent BMI.

scholarly journals Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

2021 ◽  
pp. 107110072110028
Author(s):  
Fabian Greiner ◽  
Hans-Jörg Trnka ◽  
Michel Chraim ◽  
Elena Neunteufel ◽  
Peter Bock
Keyword(s):  
Case Series ◽  
Operative Therapy ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Double Row ◽  
Postoperative Result ◽  
Foot Function ◽  
American Orthopaedic ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. Methods: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. Results: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively ( P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively ( P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up ( P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). Conclusion: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. Level of Clinical Evidence: Level IV, retrospective case series.

scholarly journals Temporal subsidence patterns of cemented polished taper-slip stems: a systematic review

2021 ◽  
Vol 6 (5) ◽  
pp. 331-342
Author(s):  
Kwaku Baryeh ◽  
Jeewaka Mendis ◽  
David H. Sochart
Keyword(s):  
Clinical Outcomes ◽  
Implant Design ◽  
Radiological Findings ◽  
Exclusion Criteria ◽  
Patient Demographics ◽  
Average Body Mass ◽  
Method Of Measurement ◽  
Average Body ◽  
Methods Of Measurement

The literature was reviewed to establish the levels of stem subsidence for both double and triple-tapered implants in order to determine whether there were any differences in subsidence levels with regard to the methods of measurement, the magnitude and rate of subsidence and clinical outcomes. All studies reporting subsidence of polished taper-slip stems were identified. Patient demographics, implant design, radiological findings, details of surgical technique, methods of measurement and levels of subsidence were collected to investigate which factors were related to increased subsidence. Following application of inclusion and exclusion criteria, 28 papers of relevance were identified. The studies initially recruited 3090 hips with 2099 being available for radiological analysis at final follow-up. Patient age averaged 68 years (42–70), 60.4% were female and the average body mass index (BMI) was 27.4 kg/m2 (24.1–29.2). Mean subsidence at one, two, five and 10 years was 0.97 mm, 1.07 mm, 1.47 mm and 1.61 mm respectively. Although double-tapered stems subsided more than triple-tapered stems at all time points this was not statistically significant (p > 0.05), nor was the method of measurement used (p > 0.05). We report the levels of subsidence at which clinical outcomes and survivorship remain excellent, but based on the literature it was not possible to determine a threshold of subsidence beyond which failure was more likely. There were relatively few studies of triple-tapered stems, but given that there were no statistically significant differences, the levels presented in this review can be applied to both double and triple-tapered designs. Cite this article: EFORT Open Rev 2021;6:331-342. DOI: 10.1302/2058-5241.6.200086

scholarly journals The aortal arch plasty in a new-born babies, using “end-to-side” anastomosis

2020 ◽  
Vol 87 (11-12) ◽  
pp. 19-22
Author(s):  
Ya. P. Truba ◽  
І. V. Dzyurii ◽  
O. O. Motrechko ◽  
O. S. Golovenko ◽  
V. V. Lazoryshynets
Keyword(s):  
Pediatric Cardiology ◽  
Late Results ◽  
Neurological Complications ◽  
Reconstructive Procedure ◽  
New Born ◽  
Average Body Mass ◽  
Cardio Vascular ◽  
Scientific Practical ◽  
Average Body

Objective. To analyze the immediate and late follow-up results of the aortal arch plasty, using anastomosis «end to side». Materials and methods. In 2010 - 2019 yrs period in Amosov National Institute of Cardio-Vascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery in 75 new-born babies, suffering coarctation and hypoplasia of one or several segments of aortal arch its reconstruction was done, using ‘end-to-side” anastomosis. Into the investigation only the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 41 (54.6%) boys and 34 (45.4%) girls. Average age of the patients was (2,5 ± 1,2) mo, and average body mass - (3.3 ± 0.6) kg. The main diagnostic method for the failure determination and immediate and late results studying was echocardiographic investigation. Results. Hospital lethality have constituted 6.6% (5 patients died). The lethality causes were not connected with the aortal arch reconstructive procedure, using anastomosis «end to side». Duration of follow-up was 1 mo - 9.3 yrs, (2.8 ± 2.5) yrs at average. In late follow-up period 1 patient died. In 11 (14.6%) patients in postoperative period the aortal arch restenosis have developed. In 7 patients restenosis was eliminated endovascularly, using balloon dilatation. In 4 patients the aortal arch surgical replasty was done. Tracheal and the main bronchi compression, neurological complications in late follow-up period were not observed. Conclusion. After plasty for the aortal arch hypoplasia, using anastomosis «end to side» in new-born babies good immediate and late follow-up results were noted, what witnesses its efficacy. In accordance to results of the investigation accomplished such kind of anastomosis applied may be used in patients, suffering hypoplasia of proximal aorta or in tubular hypoplasia of all aortal arch.

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