Prospective Analysis of Isolated Gastrocnemius Recession for Achilles Tendinopathy; Intermediate Follow-up

Abstract

Category: Ankle Introduction/Purpose: Gastrocnemius recession (GR) has emerged as a potential alternative to traditional surgical treatments in patients with recalcitrant Achilles tendinopathy (AT). Recent retrospective studies have shown positive results. However, there is limited long-term prospective data regarding the results of this surgery. We are reporting two-year results of a prospective analysis of isolated GR for Achilles tendinopathy on pain, self reported function, and satisfaction. Methods: 8 patients (mean age 52± 10.2 years) with chronic unilateral AT (> 6 months duration) and an isolated gastrocnemius contracture participated. All subjects received a GR (Strayer) procedure. Data were collected pre- and post-operatively at 6 months and 2 years. Pain and function were assessed using the Visual Analog Scale(VAS) and the Foot and Ankle Ability Measure(FAAM). Clinical measure of calf endurance was assessed by single limb heel raises and compared to the uninvolved limb. Calf circumference was evaluated and patients were queried regarding satisfaction with the GR procedure and need for further treatment. Descriptive analysis was used to assess changes across the repeated timelines. Results: All subjects returned at 6 month follow-up and 7/8 patients participated in the final follow-up (mean 23 +/- 5.5 months). Pain was reduced by 50% at 6 months and 90% at 2 years; with 6 of 7 subjects reporting no pain. Pre-op FAAM ADL subscale was 75%, improving to 90% and 97% at 6 months and 2 years, respectively. Pre-op FAAM Sports subscale was 40%, improving to 69% and 87% at 6 months and 2 years, respectively. There were no side-to-side differences in the number of heel raises performed across time frames; involved mean 26 +/- 7, uninvolved 28 +/-6. Five (of seven) subjects reported complete satisfaction with the procedure and two were satisfied with minor reservations. Conclusion: To our knowledge, this is the first study to prospectively evaluate an isolated GR for Achilles tendinopathy and present 6 month and 2-year follow-up data. Pain relief was markedly decreased and maintained at 2 years. FAAM ADL activities were restored to normative values. However, scores for the FAAM sports subscale remained slightly below normative values and may reflect patient reported difficulties with higher-level activities such as jumping and lateral movements. High satisfaction can be expected for the majority of patients, however patients engaged in higher demand activities may have a prolonged recovery period and persistent limitations.