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Isolated Gastrocnemius Recession for Achilles Tendinopathy: Strength and Functional Outcomes

Nawoczenski, Deborah A. PT, PhD; Barske, Heather MD, FRCSC; Tome, Joshua MS; Dawson, Laura K. DO; Zlotnicki, Jason P. BS; DiGiovanni, Benedict F. MD

Journal of Bone & Joint Surgery - American Volume: 21 January 2015 - Volume 97 - Issue 2 - p 99–105
doi: 10.2106/JBJS.M.01424
Scientific Articles
Disclosures

Background: Gastrocnemius recession has emerged as a viable intervention for patients with recalcitrant foot and ankle disorders associated with isolated gastrocnemius contracture. The purpose of this case-control study was to investigate the effects of an isolated gastrocnemius recession on pain, patient-reported function, and strength in patients with chronic Achilles tendinopathy and an isolated gastrocnemius contracture.

Methods: Thirteen patients with unilateral Achilles tendinopathy (mean age [and standard deviation], fifty-two ± 7.7 years) who received a gastrocnemius recession and ten matched-control subjects participated. A visual analog scale was used to assess pain, and the Foot and Ankle Ability Measure was used to evaluate patient-reported function in activities of daily living and sports. Patients were asked about their satisfaction with the results of the gastrocnemius recession. Ankle plantar flexion peak torque was assessed at 60°/sec and 120°/sec. Appropriate t tests were used to assess limb symmetry and strength differences between the groups.

Results: The mean duration of follow-up was eighteen months (range, twelve to twenty-eight months). Gastrocnemius recession provided significant pain relief (mean preoperative visual analog scale score [and standard deviation], 6.8 ± 1.8; mean follow-up visual analog scale score, 1.4 ± 2.7; p < 0.05). Foot and Ankle Ability Measure outcomes showed between-group differences in activities of daily living (Achilles tendinopathy group, 89.7; control group, 98.5; p = 0.05) and sports subscales (Achilles tendinopathy group, 71.9; control group, 95.1; p = 0.05). The activities reported to be the most challenging included going up hills, climbing stairs, running, and jumping. Eleven of the thirteen patients in the Achilles tendon group were satisfied with treatment. Side-to-side strength comparisons showed no differences at 60°/sec. Significant differences were observed at 120°/sec (Achilles tendinopathy group, 21%; control group, 3%; p < 0.05); however, the involved limb reached a peak torque similar to that in the control limb.

Conclusions: Isolated gastrocnemius recession provides significant and sustained pain relief for chronic Achilles tendinopathy. Good function can be expected for activities of daily living, but power and endurance activities were more problematic for the Achilles tendinopathy group. Isokinetic strength assessment may not effectively capture patient-reported functional deficits.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Center for Foot and Ankle Research, Rochester Center, Ithaca College, 1100 South Goodman Street, Rochester, NY 14620. E-mail address for D.A. Nawoczenski: dnawoczenski@ithaca.edu

2Winnipeg Regional Health Authority, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, Manitoba R3M 3E4, Canada

3Department of Orthopaedic Surgery, Blanchfield Army Hospital, 650 Joel Drive, Fort Campbell, KY 42223

4University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642. E-mail address for B.F. DiGiovanni: Benedict_DiGiovanni@URMC.Rochester.edu

Copyright 2015 by The Journal of Bone and Joint Surgery, Incorporated
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