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Differential elongation of the gastrocnemius after Achilles tendon rupture: a novel technique of selective shortening to treat push-off weakness with case series and literature review

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Differential elongation of the gastrocnemius after Achilles tendon rupture (ATR) may compromise the ability of athletes to return to competition. Recognition of this differential elongation of the gastrocnemius relative to the soleus is vital to treat patients with weakness in push-off. This paper describes a novel technique performed for selective shortening of the gastrocnemius to treat push-off weakness.

Methods

Three patients with differential proximal retraction of the gastrocnemius greater than 20 mm after treatment for ATR with inability to run and jump underwent surgical correction with this novel technique and were followed-up for 2 years. A novel selective shortening of the gastrocnemius with autologous hamstring graft was performed in these patients. The Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up.

Results

All three patients were able to return to running and jumping at final follow-up. The ATRS improved significantly in the strength, fatigue, running and jumping domains but there appeared to be a less notable improvement in activities of daily living domain. The AOFAS score showed improvement with the greatest margin in the domain of activity limitation.

Conclusion

This procedure is the first described selective shortening method of the gastrocnemius tendons after differential elongation following ATR. It is a safe and reliable technique providing improved ATRS and AOFAS scores in three patients who were all able to return to running and jumping sports at 2-year follow-up.

Level of evidence

IV.

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Funding

There is no funding for this study.

Author information

Authors and Affiliations

  1. Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK

    Choon Chiet Hong & James Calder

  2. Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Choon Chiet Hong

  3. Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Choon Chiet Hong

  4. Department of Orthopaedics, Naestved Hospital, Ringstedgade 61, 4700, Naestved, Denmark

    Susanne Olesen Schaarup

  5. Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK

    James Calder

Authors
  1. Choon Chiet Hong
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  2. Susanne Olesen Schaarup
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  3. James Calder
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Contributions

All authors contributed to the study conception and design. SOS and JC prepared the study design and protocol. Material preparation, data collection and analysis were performed by SOS, JC and CCH. The first draft of the manuscript was written by SOS followed by subsequent iterations by CCH and all authors commented on subsequent versions of the manuscript. JC performed the surgeries, supervised and reviewed the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Choon Chiet Hong.

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Conflict of interest

All authors do not have any conflict of interest except for James Calder who received remuneration for speaking in educational programme by Arthrex unrelated to this study.

Ethical approval

No ethical approval needed for this case series.

Informed consent

Informed consent was obtained for all three patients included in this study.

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Hong, C.C., Schaarup, S.O. & Calder, J. Differential elongation of the gastrocnemius after Achilles tendon rupture: a novel technique of selective shortening to treat push-off weakness with case series and literature review. Knee Surg Sports Traumatol Arthrosc 31, 6046–6051 (2023). https://doi.org/10.1007/s00167-023-07619-1

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  • DOI: https://doi.org/10.1007/s00167-023-07619-1

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