Endoscopic Gastrocnemius Recession 2

G.R. Scuderi and A.J. Tria (eds.), Minimally Invasive Surgery in Orthopedics: Foot and Ankle Handbook, DOI 10.1007/978-1-4614-0893-2_2, © Springer Science+Business Media, LLC 2012 Percutaneous techniques are becoming popular for treating many musculoskeletal conditions. Those developed for endoscopic carpal tunnel and plantar fascial release are currently among the most common. The reported benefi ts of endoscopic surgery include smaller incisions and shorter postoperative recovery time [ 1– 3 ] . Visualization with an endoscope may also decrease perioperative complications from scarring such as incisional irritation or neuritis, although the overall safety of these interventions has yet to be determined. An endoscopic means of gastrocnemius recession (EGR) has recently been popularized for correction of ankle equinus contracture as an alternative to formal open gastrocnemius release (OGR) or Achilles tendon lengthening [ 4– 21 ] . The OGR remains today’s gold standard for aponeurotic lengthening because of its proven record as a safe, rapid, and effective procedure. This open “slide,” however, can involve a large unsightly incision, which is particularly unpopular with young women, and can be associated with sural nerve scarring and neuritis [ 11, 14, 15, 19, 22 ] . The EGR, an alternative percutaneous approach, has been sought in an effort to avoid those problems, but it has a signifi cant learning curve, can be associated with poor visualization, and is somewhat instrument dependent [ 14, 17 ] . In consideration of its potential advantages and drawbacks, the authors have tried over the last several years to develop a safe and reliable endoscopic technique for gastrocnemius recession. Gastrocnemius recession has been used successfully for over a century to correct ankle contracture, originally described to treat neurologically impaired individuals [ 16 ] . More recent data suggesting the presence of isolated gastrocnemius tightness in otherwise healthy patients, however, has popularized more widespread use of OGR in the United States and Europe during the past decade. EGR was fi rst introduced as a treatment alternative in 2002 [ 13, 21 ] . Its purported benefi ts over the standard open means of gastrocnemius release included a smaller incision, a potentially faster recovery, and the versatility of being performed in any patient position. While its recent interest has emerged primarily in response to complications from the open technique, to date, its advantages remain promising but incompletely substantiated [ 14 ] . Early results of the endoscopic procedure appear comparable to the open technique regarding improvement of ankle dorsifl exion [ 5, 10– 12, 14, 20 ] . Using an endoscopic technique, Saxena and Widtfeldt obtained an average 15° immediate improvement in postoperative dorsifl exion, which remained at 12.6° after 1-year follow-up of 18 cases [ 14 ] . Pinney et al. reported an 18° dorsifl exion increase sustained 2 months after open Strayer procedure [ 11 ] . DiDomenico et al. reported Amol Saxena and Christopher W. DiGiovanni