• Orthopaedics Clinical Trials
• Foot & Ankle Conditions
• Orthopaedic Procedures

• Orthopaedics Clinical Trials
• Foot & Ankle Conditions
• Orthopaedics
• Orthopaedic Procedures

Results of a study comparing open and minimally invasive approaches to gastrosoleus lengthening showed similar functional outcomes for all techniques. Complications were generally lower in patients treated noninvasively except for weakness of plantar flexion, which was significantly higher in patients treated using the Hoke technique. The study results were presented by Chamnanni Rungprai, MD, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

When conservative management fails in the treatment of gastrocnemius or gastrosoleus contracture, surgical treatment is indicated. Standard techniques are open lengthening and percutaneous triple hemisections (Hoke); however, 2 newer approaches, Baumann and endoscopic, are gaining popularity. Dr Rungprai reported the results of a retrospective chart review, Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture: A Prospective Study on 320 Consecutive Patients [Phisitkul P et al. Foot Ankle Int. 2014], of 610 consecutive patients (640 legs) who received surgery at a single institution between 2006 and 2013 using 1 of 4 techniques: an open Vulpius or Strayer approach (VSO; 200 patients; 206 legs), a Baumann approach (38 patients; 38 legs), a Hoke procedure (52 patients; 52 legs), or endoscopic gastrocnemius recession (EGR; 320 patients; 344 legs). Outcome measures were the Foot Function Index (FFI), the Short Form-36 (SF-36), the visual analog scale (VAS), ankle dorsiflexion, operative time, and complications.

There were no significant differences in age, body mass index, and average time to follow-up, although Hoke patients tended to be older (around 60 years) and those receiving EGR were younger (approximately 47 years) than VSO or Baumann patients (close to 51 years). The majority of Hoke patients were men; women were in the majority in all other groups. Preoperatively, patients treated with the Baumann technique had significant equinus compared with other groups.

Functional outcomes improved for all groups postsurgery. VAS scores and scores on the SF-36 were similar for all 4 approaches, as were scores on the FFI for pain, disability, activity limitation, and total score. Operative time was considerably shorter for the Hoke procedure (3.1 ± 1.1 minutes; range, 2 to 5 minutes) compared with the 3 other procedures, which ranged from 18.2 ± 5 minutes for the endoscopic approach to 28.1 ± 5.1 minutes and 29 ± 6.5 minutes for the VSO and Baumann approaches, respectively.

Hoke patients had significantly less correction immediately postsurgery and at final follow-up, and less ankle dorsiflexion at final follow-up, compared with the other groups. Ankle range of motion preoperatively, immediately postoperatively, and at final follow-up for all groups is shown in Table 1.

A significantly higher rate of superficial infection was seen with the invasive procedures compared with the less invasive approaches. Weakness of plantar flexion was significantly higher in Hoke patients. The approaches did not differ in the rate of sural nerve dysesthesia, painful scar, and calf muscle atrophy (Table 2).

This study is limited by the fact that it was retrospective, by the inherent difficulty in comparing outcomes from different sources of contracture, and because the surgical techniques were selected by surgeon preference.

In this study, all techniques led to significant improvement of functional outcomes. The Hoke technique was associated with significantly shorter operative time but less equinus correction and a higher incidence of plantar flexion weakness. Patients treated with EGR had lower rates of wound complications and painful scar. There was a low incidence of sural nerve symptoms and weakness of plantar flexion with all 4 approaches.

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