BACKGROUND: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment. MATERIALS AND METHODS: A prospective case series of all patients with a minimum 1-year symptomatic noninsertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons). RESULTS: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively (p < 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year (p < 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications. CONCLUSION: Gastrocnemius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome.
BACKGROUND: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment. MATERIALS AND METHODS: A prospective case series of all patients with a minimum 1-year symptomatic noninsertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons). RESULTS: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively (p < 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year (p < 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications. CONCLUSION: Gastrocnemius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome.
Authors: A Barile; F Bruno; S Mariani; F Arrigoni; L Brunese; M Zappia; A Splendiani; E Di Cesare; C Masciocchi Journal: Musculoskelet Surg Date: 2017-02-14
Authors: Karin Grävare Silbernagel; Peter Malliaras; Robert-Jan de Vos; Shawn Hanlon; Mitchel Molenaar; Håkan Alfredson; Inge van den Akker-Scheek; Jarrod Antflick; Mathijs van Ark; Kenneth Färnqvist; Zubair Haleem; Jean-Francois Kaux; Paul Kirwan; Bhavesh Kumar; Trevor Lewis; Adrian Mallows; Lorenzo Masci; Dylan Morrissey; Myles Murphy; Richard Newsham-West; Richard Norris; Seth O'Neill; Koen Peers; Igor Sancho; Kayla Seymore; Patrick Vallance; Arco van der Vlist; Bill Vicenzino Journal: Sports Med Date: 2021-11-19 Impact factor: 11.136