Comparison of the efficacy of three isolated gastrocnemius recession procedures in a cadaveric model of gastrocnemius tightness.

PURPOSE: Many surgical techniques for isolated gastrocnemius recession have been described. The purpose of the present study is to compare their therapeutic efficacy and intrinsic stability on a fresh cadaveric model of gastrocnemius tightness. METHODS: The cadaveric model was established by distracting the knee with spacers composed of low-temperature thermoplastic material, and was identified by the Silfverskiöld test. Procedures of gastrocnemius recession described by Barouk, Baumann and Strayer were performed. The lengthening distance and improvement of ankle dorsiflexion were measured. RESULTS: The mean ankle angle of the cadaveric models was -15.4° with the knee fully extended, and 8.4° with the knee flexed. The increased angle achieved by the Strayer procedure was significantly greater than that achieved by the Barouk procedure and the Baumann procedure with one cut (P < 0.05), but similar to that of the Baumann procedure with two cuts (P > 0.05). Compared with the intramuscular lengthening of the gastrocnemius (Baumann and Barouk procedures), the stability of the lengthening after the Strayer procedure was the lowest. CONCLUSION: The three techniques of isolated gastrocnemius recession have different efficacy and stability in cadaver trials, depending on their own anatomical characteristics. Our study supplies an anatomical guide for the selection of a proper procedure.

Mid-term Results of Intramuscular Lengthening of Gastrocnemius and/or Soleus to Correct Equinus Deformity in Flatfoot.

BACKGROUND: Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity. METHODS: We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications. RESULTS: Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was -4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees (P < .001) and 9.7 degrees (P < .001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems. CONCLUSIONS: Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications. LEVEL OF EVIDENCE: Level IV, retrospective case series.