AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Gastroc Recession_ When Is It Indicated and How to Do Arthroscopically-Peter Mangone, M.D.

Gastroc Recession_ When Is It Indicated and How to Do Arthroscopically-Peter Mangone, M.D.

Pdf Summary

This presentation by Dr. Peter G. Mangone at the AANA Foot & Ankle Scope Course in June 2019 focuses on the anatomy, pathology, and treatment of Achilles tendon contracture, particularly gastrocnemius contracture, and related surgical interventions. The Achilles tendon comprises two primary components: the soleus and the gastrocnemius (which has medial and lateral heads). Differentiation of Achilles contracture is assessed via the Silfverskiöld test, measuring dorsiflexion with the knee both extended and flexed.<br /><br />Gastrocnemius contracture can contribute to various foot and ankle pathologies such as metatarsalgia, midfoot osteoarthritis, pes planovalgus, adult acquired flatfoot, Charcot midfoot fractures, plantar fasciitis, and diabetic foot ulcerations. Treatment options include surgical gastrocnemius recession to alleviate contracture. <br /><br />The original gastrocnemius recession, described by Silfverskiöld, involved detaching muscle heads from the femoral condyles and reattaching them to the proximal tibia. The Strayer procedure, introduced in 1950, performs the recession at the mid-calf level via a posterior or posteromedial incision, careful to identify and protect the sural nerve—which has variable anatomical relations to the gastrocnemius and soleus muscles.<br /><br />Endoscopic gastrocnemius recession, first published by Tashjian et al. in 2002, uses a two-portal approach with specialized instruments (e.g., slotted cannula, reverse cutting knife, 30-degree endoscope). This minimally invasive technique has been reported in multiple studies to treat gastrocnemius equinus effectively, including in pediatric and diabetic populations, though certain complications have been noted.<br /><br />The presentation includes references to operative technique, anatomy, and relevant literature, alongside images and an animation video to illustrate the procedure. Multiple commercially available kits exist, but surgeons may also assemble their own endoscopic setups. This approach aims to improve patient outcomes by addressing gastrocnemius contracture in a less invasive manner compared to traditional open techniques.

Keywords

Achilles tendon

Gastrocnemius contracture

Silfverskiöld test

Gastrocnemius recession

Strayer procedure

Endoscopic gastrocnemius recession

Foot and ankle pathology

Sural nerve

Minimally invasive surgery

Diabetic foot ulcerations