Reconstruction of Overlengthening After Gastrocnemius Recession With an Achilles Tendon Allograft

Gastrocnemius recession is a common procedure in foot and ankle surgery used mostly to release tension in the triceps surae complex when ankle dorsiflexion is insufficient. Initially reserved for pediatric population, this type of release is now also widely used in adult pathologies. A wide array of complications has been described in association with gastrocnemius recession, including deep wound infection, adhesions, sural nerve damage, decreased calf circumference, as well as strength loss and contracture recurrence. To our knowledge, an overlengthening after gastrocnemius recession surgery has not been described so far. The level of contracture in the gastrocnemius-soleus complex can reliably be determined by the Silfverskiöld test, which aids in decision making for the type of lengthening needed. If dorsiflexion is limited with both the knee flexed and extended, then both the gastrocnemius and soleus are tight and have to be released as in the complete (Vulpius) or partial (pie crusting) soleal aponeurotomy or Achilles tendon lengthening. Otherwise, if dorsiflexion is increased with knee flexion, then only the gastrocnemius is too tight and its isolated release should be sufficient such as in the Silfverskiöld proximal gastrocnemius release, the Baumann gastrocnemius aponeurotomy, and the Strayer distal gastrocnemius disinsertion. However, anatomic variations exist at the insertion of the gastrocnemius tendon on the soleus tendon. When a distinct separation is identified intraoperatively, isolated release of those tendons is feasible. Otherwise, if the gastrocnemius muscle fibers insert directly on the soleus tendon, it is common practice to release both simultaneously, despite Silfverskiöld results, through an aponeurotomy just distal to the gastrocnemius insertion on the soleus leaving the latter muscle fibers in continuity (Vulpius). To avoid confusion with these variants, the term gastrocnemius recession will be used in the present article. Because triceps surae overlengthening has not been described after this procedure, a consistently successful treatment for this complication has not yet been published either. Most studies published to date have focused on treatment of chronic Achilles tendon ruptures or failed treatment of acute ruptures. Many techniques have been described, such as primary repair, augmentation with free fascia tendon graft, fascial advancement or local tendon transfers such as the flexor hallucis longus (FHL), synthetic graft, and allograft. Still, no consensus exists over the best technique to use in such cases. In this article, we report a case of triceps surae overlengthening after gastrocnemius recession in a patient who underwent flatfoot deformity surgery, treated by an Achilles tendon allograft. To our knowledge, this is the first published report on this specific complication following the common gastrocnemius recession procedure. 655354 FAIXXX10.1177/1071100716655354Foot & Ankle InternationalBenny et al research-article2016