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International Orthopaedics

, Volume 39, Issue 1, pp 61–65 | Cite as

Release of the medial head of the gastrocnemius for Achilles tendinopathy in sedentary patients: a retrospective study

  • Nicola MaffulliEmail author
  • Angelo Del Buono
Original Paper

Abstract

Purpose

Our aim was to ascertain whether releasing the medial head of he gastrocnemius improves clinical and functional outcomes of sedentary patients with long-standing tendinopathy of the main body of the Achilles tendon and allows return to daily activities.

Methods

Eighteen patients (seven men, 11 women) underwent release of the gastrocnemius medial head to manage chronic unilateral Achilles tendinopathy. Pre- and postoperatively, each patient completed the Victorian Institute of Sports Assessment–Achilles tendon (VISA-A) questionnaire. The maximum calf circumference and isometric plantar flexion strength of the gastrocsoleus complex were measured in both the affected and the contralateral leg. Function was scored using the 4-point Boyden scale at the last assessment.

Results

At the last appointment, at an average follow-up of 54 months, maximum calf circumference and strength of the operated leg were not significantly different than pre-operatively and were significantly lower than the contralateral leg. All patients could satisfactorily perform the same work and daily activities as before symptom onset. At the last follow-up, the average VISA-A score was improved from a preoperative average value of 52.3 to 75 (range 51–94) (p < .001).

Conclusions

This approach to managing isolated Achiles tendinopathy is safe, effective, low cost and allows safe return to preinjury daily activities.

Keywords

Sedentary patients Chronic Achilles tendinopathy Gastronemius medial-head release Return to daily activities 

Notes

Conflict of interests

None.

References

  1. 1.
    James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6:40–50PubMedCrossRefGoogle Scholar
  2. 2.
    Maffulli N, Del Buono A, Spiezia F, Longo UG, Denaro V (2012) Light microscopic histology of quadriceps tendon ruptures. Int Orthop 36:2367–2371PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Del Buono A, Oliva F, Longo UG, Rodeo SA, Orchard J, Denaro V, Maffulli N (2012) Metalloproteases and rotator cuff disease. J Shoulder Elbow Surg 21:200–208PubMedCrossRefGoogle Scholar
  4. 4.
    Leppilahti J, Orava S, Karpakka J, Takala T (1991) Overuse injuries of the Achilles tendon. Ann Chir Gynaecol 80:202–207PubMedGoogle Scholar
  5. 5.
    Maffulli N, Dymond NP, Regine R (1990) Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med 11:78–84PubMedCrossRefGoogle Scholar
  6. 6.
    Maffulli N, Testa V, Capasso G, Bifulco G, Binfield PM (1997) Results of percutaneous longitudinal tenotomy for Achilles tendinopathy in middle- and long- distance runners. Am J Sports Med 25:835–840PubMedCrossRefGoogle Scholar
  7. 7.
    Rompe JD, Furia JP, Maffulli N (2008) Mid-portion Achilles tendinopathy–current options for treatment. Disabil Rehabil 30:1666–1676PubMedCrossRefGoogle Scholar
  8. 8.
    Del Buono A, Battery L, Denaro V, Maccauro G, Maffulli N (2011) Tendinopathy and inflammation: some truths. Int J Immunopathol Pharmacol 24(1 Suppl 2):45–50Google Scholar
  9. 9.
    Franceschi F, Papalia R, Paciotti M, Franceschetti E, Di Martino A, Maffulli N, Denaro V (2014) Obesity as a risk factor for tendinopathy: a systematic review. Int J Endocrinol 2014;2014:670262Google Scholar
  10. 10.
    Del Buono A, Oliva F, Osti L, Maffulli N (2013) Metalloproteases and tendinopathy. Muscles Ligaments Tendons J 21;3(1):51–7Google Scholar
  11. 11.
    Rowe V, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D (2012) Management of midportion achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. Sports Med 42:941–967PubMedCrossRefGoogle Scholar
  12. 12.
    Gurdezi S, Kohls-Gatzoulis J, Solan MC (2013) Results of proximal medial gastrocnemius release for Achilles tendinopathy. Foot Ankle Int 34:1364–13699PubMedCrossRefGoogle Scholar
  13. 13.
    Kiewiet NJ, Holthusen SM, Bohay DR, Anderson JG (2013) Gastrocnemius recession for chronic noninsertional Achilles tendinopathy. Foot Ankle Int 34:481–485PubMedCrossRefGoogle Scholar
  14. 14.
    Abbassian A, Kohls-Gatzoulis J, Solan MC (2012) Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis. Foot Ankle Int 33:14–19PubMedCrossRefGoogle Scholar
  15. 15.
    Hamilton PD, Brown M, Ferguson N, Adebibe M, Maggs J, Solan M (2009) Surgical anatomy of the proximal release of the gastrocnemius: a cadaveric study. Foot Ankle Int 30:1202–1206PubMedCrossRefGoogle Scholar
  16. 16.
    Maffulli N, Kenward MG, Testa V, Capasso G, Regine R, King JB (2003) Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med 13:11–15PubMedCrossRefGoogle Scholar
  17. 17.
    Maffulli N, Regine R, Angelillo M, Capasso G, Filice S (1987) Ultrasound diagnosis of Achilles tendon pathology in runners. Br J Sports Med 21:158–162PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Crisp T, Khan F, Padhiar N et al (2008) High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa’s body are effective in chronic patellar tendinopathy: a pilot study. Disabil Rehabil 30:1625–1634PubMedCrossRefGoogle Scholar
  19. 19.
    Rompe JD, Furia J, Maffulli N (2009) Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med 37:463–470PubMedCrossRefGoogle Scholar
  20. 20.
    Padhiar N, Al-Sayeagh H, Chan O, King J, Maffulli N (2008) Pennation angle of the soleus in patients with unilateral Achilles tendinopathy. Disabil Rehabil 30:1640–1645PubMedCrossRefGoogle Scholar
  21. 21.
    Shaikh Z, Perry M, Morrissey D, Ahmad M, Del Buono A, Maffulli N (2012) Achilles tendinopathy in club runners. Int J Sports Med 33:390–394PubMedCrossRefGoogle Scholar
  22. 22.
    Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N (2013) Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 11:14–19PubMedCrossRefGoogle Scholar
  23. 23.
    De Lalla F, Viola R, Pellizzer G, Lazzarini L, Tramarin A, Fabris P (2000) Regional prophylaxis with teicoplanin in monolateral or bilateral total knee replacement: an open study. Antimicrob Agents Chemother 44:316–319PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    de Lalla F (2001) Antibiotic prophylaxis in orthopedic prosthetic surgery. J Chemother 13:48–53PubMedCrossRefGoogle Scholar
  25. 25.
  26. 26.
    Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V (2008) Italian translation of the VISA-A score for tendinopathy of the main body of the Achilles tendon. Disabil Rehabil 30:1635–1639PubMedCrossRefGoogle Scholar
  27. 27.
    Boyden EM, Kitaoka HB, Cahalan TD, An KN (1995) Late versus early repair of Achilles tendon rupture. Clinical and biomechanical evaluation. Clin Orthop Relat Res 317:150–158PubMedGoogle Scholar
  28. 28.
    Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N (2002) Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med 12:273–278PubMedCrossRefGoogle Scholar
  29. 29.
    Cameron N (1984) The measurement of human growth. Croom Helm, Beckenham 56–99Google Scholar
  30. 30.
    Jhingan S, Perry M, O’Driscoll G et al (2011) Thicker Achilles tendons are a risk factor to develop Achilles tendinopathy in elite professional soccer players. Muscle Ligament Tendon J 1:51–56Google Scholar
  31. 31.
    Maffulli N, Binfield PM, Moore D, King JB (1999) Surgical decompression of chronic central core lesions of the Achilles tendon. Am J Sports Med 27:747–752PubMedGoogle Scholar
  32. 32.
    Tallon C, Coleman BD, Khan KM, Maffulli N (2001) Outcome of surgery for chronic Achilles tendinopathy. A critical review. Am J Sports Med 29:315–320PubMedGoogle Scholar
  33. 33.
    Sayana MK, Maffulli N (2007) Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport 10:52–58PubMedCrossRefGoogle Scholar
  34. 34.
    Chimera NJ, Castro M, Manal K (2010) Function and strength following gastrocnemius recession for isolated gastrocnemius contracture. Foot Ankle Int 31:377–384PubMedCrossRefGoogle Scholar
  35. 35.
    Morton D (1935) The human foot: its evolution, physiology, and functional disorders. Columbia University, New YorkGoogle Scholar
  36. 36.
    Gentchos CE, Bohay DR, Anderson JG (2008) Gastrocnemius recession as treatment for refractory achilles tendinopathy: a case report. Foot Ankle Int 29:620–623PubMedCrossRefGoogle Scholar
  37. 37.
    Costa ML, Donell ST, Tucker K (2006) The long-term outcome of tendon lengthening for chronic Achilles tendon pain. Foot Ankle Int 27:672–676PubMedGoogle Scholar
  38. 38.
    Duthon VB, Lubbeke A, Duc SR, Stern R, Assal M (2011) Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening. Foot Ankle Int 32:375–379PubMedCrossRefGoogle Scholar
  39. 39.
    Young JS, Kumta SM, Maffulli N (2005) Achilles tendon rupture and tendinopathy: management of complications. Foot Ankle Clin 10:371–382PubMedCrossRefGoogle Scholar
  40. 40.
    Williams JG, Sperryn PN, Boardman S, Street M, Mellett S, Parsons C (1976) Post- operative management of chronic achilles tendon pain in sportsmen. Physiotherapy 62:256–259PubMedGoogle Scholar
  41. 41.
    Maffulli N, Testa V, Capasso G et al (2006) Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients. Clin J Sport Med 16:123–128PubMedCrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  1. 1.Centre for Sports and Exercise MedicineQueen Mary University of LondonLondonUK
  2. 2.Department of Orthopaedics and TraumatologySant’Anna HospitalSan Fermo della Battaglia (Como)Italy

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