The Medial Gastrocnemius Release: A Safe and Effective Alternative for Treatment of Isolated Gastrocnemius Contracture

CATEGORY: Basic Sciences/Biologics INTRODUCTION/PURPOSE: Gastrocnemius recession is a popular procedure utilized to treat a myriad of lower extremitychronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing the variable relationship between the distal gastrocnemius and soleus tendons has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may offer comparable clinical results while avoiding the surgical risk related to conjoint tendon anatomical variability. METHODS: Ten matched pairs of above-knee fresh frozen cadavers were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession 'Baumann' procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed post-operative surgical dissections were performed on all specimens to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. RESULTS: MGR and GIAR procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. 35% of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus, with sections of no distal transactable gastrocnemius tendon present. CONCLUSION: The MGR produced comparable results to the Baumann/GIAR in a cadaver model. We feel that the MGR is an attractive alternative to traditional gastrocnemius recession techniques due to the simple approach, the region's predictable anatomy, its low risk to surrounding vital structures, and its early evidence of effectiveness. We also concluded that the conjoint tendon anatomy is highly variable and that surgeons must account for this unpredictability when surgically treating IGC. We predict that the biggest risk associated with conjoint tendon region recession procedures is inadvertent soleus transection and subsequent over lengthening related plantar flexion weakness.