A novel technique of isolated gastrocnemius recession: A cadaveric comparison with Strayer procedure

Background Strayer’s gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim 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 of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques. Results 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 (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829). Conclusions Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them. Level of Evidence Level II, randomized controlled trial.

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Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

Foot & Ankle International ◽

10.1177/1071100719858621 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1189-1194 ◽

Cited By ~ 3

Author(s):

Paul M. C. Dearden ◽

Robbie I. Ray ◽

Peter W. Robinson ◽

Caroline R. Varrall ◽

Thomas J. Goff ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Score ◽

Hallux Valgus ◽

Controlled Trial ◽

Adverse Outcomes ◽

Recurrence Rates ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Forefoot Surgery ◽

Significant Difference

Background: It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. Methods: One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. Results: At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. Conclusion: Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. Level of Evidence: Level II, prospective randomized controlled trial.

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Proposal of a Modified Comprehensive Technique to Avoid Local Scarring and Adhesion Formation for Isolated Gastrocnemius Recession: a Comparison Study.

10.21203/rs.3.rs-700251/v1 ◽

2021 ◽

Author(s):

Jiafa Zheng ◽

Xiufeng Song ◽

Min Guan ◽

Zhiming Qi

Keyword(s):

Clinical Evidence ◽

Adhesion Formation ◽

Ankle Dorsiflexion ◽

Comparison Study ◽

Modified Technique ◽

Significant Difference ◽

Gastrocnemius Recession ◽

Adhesion Rate ◽

The Mean ◽

Group 1

Abstract BackgroundPoor cosmesis is one of the complications following surgical gastrocnemius recession by Strayer procedure. Our present study reported a modified comprehensive technique avoiding skin adhesion in releasing gastrocnemius contracture. A comparison cohort was conducted with inclusion cases via comprehensive modified technique and conventional Strayer procedure. MethodsFrom July 2017 to December 2019, 72 consecutive patients (84 feet) were retrospectively reviewed with 38 cases（42 feet）treated utilizing conventional Strayer procedure and 34 cases（42 feet）treated by modified comprehensive technique. All patients were followed up for minimum 12 months (mean 13.6, range 12 to 18 months). The ankle dorsiflexion range of motion and medical complications (scar adhesion) of above patients were recorded and evaluated. ResultsThe mean ankle dorsiflexion significantly improved from 14.5º±2.5º degrees preoperatively to -18.7º±3.2º degrees in modified procedure group postoperatively (P<0.05), while dorsiflexion improved from 15.2º±3.0º to -19.1º±3.9º in conventional Strayer procedure group. 1 of 42 (2.4%) in modified procedure group developed scar adhesion while 12 of 42 (28.6%) in conventional Strayer procedure group, which showed a statistically significant difference in postoperative complication (scar adhesion) rate between two groups (P<0.05). ConclusionsGastrocnemius recession with modified comprehensive technique can completely release the gastrocnemius aponeurosis and achieve satisfactory recovery of ankle dorsiflexion angle, especially effectively avoid postoperative local scar adhesion with a superior cosmetic appearance.Level of Clinical Evidence: 3

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Comparative Outcomes and Complications of Open versus Endoscopic Gastrocnemius Recession: A Prospective Randomized Control Trial

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00416 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0041

Author(s):

Chamnanni Rungprai ◽

Yantarat Sripanich ◽

Warongporn Pongpinyopap

Keyword(s):

Short Form ◽

Ankle Dorsiflexion ◽

Endoscopic Technique ◽

Wound Complications ◽

Endoscopic Techniques ◽

Operative Outcomes ◽

Sf 36 ◽

Significant Difference ◽

Gastrocnemius Recession ◽

Open Versus

Category: Other Introduction/Purpose: Both open and endoscopic gastrocnemius recession are commonly used for treatment of gastrosoleus contracture, however; there was a paucity of evidence in literatures to compare post-operative outcomes between the two techniques. The purpose of this study is to compare outcomes and complications between open and endoscopic techniques. Methods: A prospective, randomized collected data of 53 consecutive patients who were diagnosed with gastrosoleus contracture and underwent either open (26 patients) or endoscopic (27 patients) gastrocnemius recession between 2016 and 2018. The primary outcome was ankle dorsiflexion and secondary outcomes were visual analogue scale (VAS), Short Form-36 (SF- 36), FAAM, plantarflexion weakness, operative times, and complications. Results: There were 53 patients with mean age of 49.1 years, mean BMI of 26.5 kg/m2, and mean follow-up of 11.5 months. Both techniques demonstrated significant improvement of ankle dorsiflexion (12.1 vs 11.3 degrees, p<0.001) and all functional outcomes (FAAM, SF-36, and VAS (p<0.001 all)); however, there was no significant difference between the two groups, (p>0.05 all). In addition, there were significant shorter operative times in endoscopic technique (7.3 vs 18.7 minutes, p<0.01). Complications included wound complications (3.8 vs 0%), painful scar (7.7 vs 0%), sural nerve injury (3.8 vs 0%), and plantarflexion weakness (3.8 vs 3.8%) for open and endoscopic techniques respectively. Conclusion: Both open and endoscopic techniques were demonstrated significant improvement of post-operative outcomes as measured with ankle dorsiflexion, FAAM, SF-36, and VAS. Although the post-operative outcomes were not significantly different between the two groups, the endoscopic technique demonstrated lesser complications and shorter operative times.

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Effect of Syndesmotic Implant Removal on Dorsiflexion

Foot & Ankle International ◽

10.1177/1071100718818572 ◽

2019 ◽

Vol 40 (5) ◽

pp. 499-505 ◽

Cited By ~ 6

Author(s):

Jorge Briceno ◽

Timilien Wusu ◽

Philip Kaiser ◽

Patrick Cronin ◽

Alyssa Leblanc ◽

...

Keyword(s):

Final Analysis ◽

Ankle Dorsiflexion ◽

Implant Removal ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Level Ii ◽

Significant Difference ◽

Before And After ◽

The Mean

Background: There is limited evidence that syndesmotic implant removal (SIR) is beneficial. However, many surgeons advocate removal based on studies suggesting improved motion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after SIR using radiographically measured motion before and after screw removal utilizing a standardized load. Methods: All patients undergoing isolated SIR were candidates for inclusion. Dorsiflexion was measured radiographically: (1) immediately before implant removal intraoperatively, (2) immediately after removal intraoperatively, and (3) 3 months after removal. A standardized torque force was applied to the ankle and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured dorsiflexion on randomized, deidentified images. A total of 29 patients met inclusion criteria. All syndesmotic injuries were associated with rotational ankle fractures. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). Results: The mean ankle dorsiflexion pre-operatively, post-operatively, and at a 3-month follow-up was 13.7 ± 6.6 degrees, 13.3 ± 7.3 degrees and 11.8 ± 11.3 degrees, respectively ( P = .466). For subsequent analysis, 5 patients were excluded because of the potential confounding effect of retained suture button devices. Analysis of the remaining 24 patients (and final analysis of 21 patients who had complete 3-month follow-up) demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all 3 time points. Conclusion: Removal of syndesmotic screws may not improve ankle dorsiflexion motion and should not be used as the sole indication for screw removal. Level of Evidence: Level II, prospective cohort study.

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Effects of gastrocnemius stretching with talus-stabilizing taping on ankle dorsiflexion and balance in individuals with limited ankle dorsiflexion: A randomized controlled trial

Isokinetics and Exercise Science ◽

10.3233/ies-210165 ◽

2021 ◽

pp. 1-9

Author(s):

Jong-Chul Jung ◽

Yong-Il Shin ◽

Da-In An ◽

Won-Young Park ◽

Soo-Yong Kim

Keyword(s):

Repeated Measures ◽

Controlled Trial ◽

Ankle Dorsiflexion ◽

Long Term Effects ◽

Post Intervention ◽

Balance Test ◽

Randomized Controlled ◽

Repeated Measures Analysis ◽

Significant Difference

BACKGROUND: Various interventions have been recommended to increase ankle dorsiflexion range of motion (DFROM); however, few studies have investigated the long-term effects of applying gastrocnemius stretching with talus-stabilizing taping (GSTST). OBJECTIVE: To compare the effects of gastrocnemius stretching (GS) and GSTST on DFROM and balance in subjects with limited DFROM. METHODS: Twenty-six subjects with limited DFROM were randomly allocated to either the GS group (n= 13) or GSTST group (n= 13) for 6 weeks. Maximum DFROM before heel-off during gait, passive DFROM, posterior talar glide, flexibility of the gastrocnemius, and the lower-quarter Y-balance test (YBT-LQ) were assessed pre-intervention and post-intervention. Two-way repeated-measures analysis of variance was used to compare the changes in variables. RESULTS: The GSTST group had greater maximum DFROM before heel-off, passive DFROM, and posterior talar glide than the GS group. Gastrocnemius flexibility and YBT-LQ scores increased significantly post-intervention in both groups; however, there was no significant difference between the groups. CONCLUSIONS: GSTST is recommend for improving ankle DFROM and balance in subjects with limited DFROM.

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Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty

Aesthetic Surgery Journal ◽

10.1093/asj/sjab070 ◽

2021 ◽

Author(s):

Per Hedén ◽

Sebastian Fischer

Keyword(s):

Online Survey ◽

Study Groups ◽

Fat Grafting ◽

Fat Graft ◽

The Novel ◽

Level Of Evidence ◽

Lower Blepharoplasty ◽

Novel Technique ◽

Tear Trough ◽

Tear Trough Deformity

Abstract Background Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. Objectives The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. Methods A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. Results There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. Conclusions The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. Level of Evidence: 4

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Novel Technique of Transepithelial Corneal Cross-Linking Using Iontophoresis in Progressive Keratoconus

Journal of Ophthalmology ◽

10.1155/2016/7472542 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Marco Lombardo ◽

Sebastiano Serrao ◽

Paolo Raffa ◽

Marianna Rosati ◽

Giuseppe Lombardo

Keyword(s):

Controlled Trial ◽

Cross Linking ◽

The Novel ◽

Novel Technique ◽

Randomized Controlled ◽

Average Improvement ◽

Corrected Distance Visual Acuity ◽

Spherical Equivalent Refraction

In this work, the authors presented the techniques and the preliminary results at 6 months of a randomized controlled trial (NCT02117999) comparing a novel transepithelial corneal cross-linking protocol using iontophoresis with the Dresden protocol for the treatment of progressive keratoconus. At 6 months, there was a significant average improvement with an average flattening of the maximum simulated keratometry reading of0.72±1.20 D (P=0.01); in addition, corrected distance visual acuity improved significantly (P=0.08) and spherical equivalent refraction was significantly less myopic (P=0.02) 6 months after transepithelial corneal cross-linking with iontophoresis. The novel protocol using iontophoresis showed comparable results with standard corneal cross-linking to halt progression of keratoconus during 6-month follow-up. Investigation of the long-term RCT outcomes are ongoing to verify the efficacy of this transepithelial corneal cross-linking protocol and to determine if it may be comparable with standard corneal cross-linking in the management of progressive keratoconus.

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A Randomized Controlled Trial of Hydroxychloroquine as Prophylaxis for COVID-19 among Health Care Providers

The Open Public Health Journal ◽

10.2174/1874944502114010600 ◽

2021 ◽

Vol 14 (1) ◽

pp. 600-604

Author(s):

Ramin Parvizrad ◽

Ghasem Mosayebi ◽

Nader Zarinfar ◽

Morteza Mousavi-Hasanzadeh ◽

Seyedeh Zahra Razavi ◽

...

Keyword(s):

Health Care Providers ◽

Controlled Trial ◽

White Blood Cells ◽

Intervention Group ◽

Healthcare Services ◽

Care Group ◽

Control Group ◽

Care Providers ◽

Level Of Evidence ◽

Significant Difference

Background: Although there is a growing consensus that hydroxychloroquine may not be effective in the treatment of COVID-19 patients, there is still little high-quality evidence about the prophylactic effects of this medication. In this study, we aimed to evaluate the efficiency of hydroxychloroquine in preventing COVID-19 infection among healthcare workers. Methods: In this clinical trial, 90 healthcare providers from two referral hospitals of COVID-19 were divided into the hydroxychloroquine group (400 mg/week for eight weeks) and the routine-care group. Serum CRP levels and the frequency of T-helper (CD4+ cells) and T-cytotoxic (CD8+ cells) were assessed at the beginning and end of the study. The groups were compared in terms of White Blood cells (WBCs), polymorph nuclear cells (PMNs), lymphocytes (LYM), hemoglobin (Hb), and platelets (Plt.). Results: The results revealed no significant differences between the two groups in terms of WBC, PMN, LYM, Hb, Plt., CD4, and CD8. The mean difference of the CD4:CD8 ratio showed a significantly higher decrease (P=0.05) in hydroxychloroquine group than in the control group (0.18 vs. 0.02). The incidence of COVID-19 was 15% (95%CI: 12-18%) in the control group and 10% (95%CI: 8-12%) in the intervention group; however, no significant difference was observed between the two groups in this regard (P=0.45). Conclusion: Our study findings boost an increasing level of evidence that hydroxychloroquine is not an effective prophylactic medication against COVID-19 and might even exacerbate the profile of pandemic containment efforts by adding more pain to patients’ life and healthcare services.

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Radiofrequency Microtenotomy

The American Journal of Sports Medicine ◽

10.1177/0363546508318045 ◽

2008 ◽

Vol 36 (10) ◽

pp. 1960-1965 ◽

Cited By ~ 42

Author(s):

Khaled Meknas ◽

Åshild Odden-Miland ◽

James B. Mercer ◽

Miguel Castillejo ◽

Oddmund Johansen

Keyword(s):

Infrared Thermography ◽

Controlled Trial ◽

Extensor Tendon ◽

Functional Score ◽

Objective Method ◽

Level Of Evidence ◽

Promising Alternative ◽

Pain Scores ◽

Significant Difference ◽

Release Group

Background Recalcitrant lateral epicondylitis (elbow tendinosis) is a common cause of elbow pain. There are many forms of treatment, none being superior. Hypothesis The main hypothesis tested in this study is that radiofrequency microtenotomy offers better results than the extensor tendon release and repair operation for elbow tendinosis, especially earlier recovery. Study Design Randomized controlled trial; Level of evidence, 1. Methods Twenty-four patients were randomized into 2 treatment groups, extensor tendon release and repair, and microtenotomy. Dynamic infrared thermography (DIRT) was employed as an objective method to verify the diagnosis as well as to document the outcome 3 months after the surgical procedure. Results Visual analog scale pain scores in the microtenotomy but not in the release group decreased significantly after 3 weeks. There was no statistically significant difference in pain scores between the 2 groups at 3, 6, and 12 weeks, and at 10 to 18 months. At 12 weeks, grip strength had improved significantly in the microtenotomy but not in the release group. The functional score was significantly increased in both groups. The DIRT group showed significant differences in epicondyle skin temperature between diseased and normal elbows both pre- and postoperatively. Abnormal DIRT images correlated well with elevated pain scores. Conclusions Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis. Dynamic infrared thermography provides a reliable, noninvasive, objective method for the diagnosis of elbow tendinosis, as well as for evaluation of the outcome following treatment.

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Laparoscopic Heller Myotomy and Fundoplication: What Is the Evidence?

The American Surgeon ◽

10.1177/000313481808400418 ◽

2018 ◽

Vol 84 (4) ◽

pp. 481-488 ◽

Cited By ~ 4

Author(s):

Fabrizio Rebecchi ◽

Marco E. Allaix ◽

Francisco Schlottmann ◽

Marco G. Patti ◽

Mario Morino

Keyword(s):

Heller Myotomy ◽

Controlled Trial ◽

Standard Of Care ◽

Laparoscopic Heller Myotomy ◽

Current Evidence ◽

Partial Fundoplication ◽

Level Of Evidence ◽

Randomized Controlled ◽

Total Fundoplication ◽

Significant Difference

There is no agreement about the best type of fundoplication to add in patients undergoing laparoscopic Heller myotomy (LHM) for achalasia to reduce the risk of postoperative gastroesophageal reflux. This article reviews the current evidence about the outcomes in achalasia patients undergoing LHM with a partial anterior, a partial posterior, or a total fundoplication. We performed a review of the literature in PubMed/Medline electronic databases, which was evaluated according to the GRADE system. The results of the published randomized controlled trials show with a high level of evidence that the addition of a fundoplication reduces the risk of postoperative abnormal reflux, without impairing the food emptying of the esophagus. LHM with partial fundoplication is considered in most centers worldwide the standard of care for the treatment of patients with achalasia. The current evidence fails to show any significant difference between partial anterior and posterior fundoplication. In the absence of further large randomized controlled trial, the decision of performing an anterior or a posterior wrap is based on the surgeon's experience and preference. The addition of a partial fundoplication to LHM leads to a significantly lower rate of postoperative pathological reflux without impairing the esophageal emptying.

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