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Gastrocnemius Recession 27687

 
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms: Strayer procedure

 Gastocnemius Recession CPT

Gastocnemius Recession Indications

  • Achilles Tendinopathy
  • Isolated gastrocnemius contracture

 Gastocnemius Recession Contraindications

  • Normal ankle ROMds

Gastocnemius Recession Alternatives

  • Conservative care
  • Achilles tendon lengthening
  • Tendon debriement and repair

Gastocnemius Recession Pre-op Planning

  • Document a positive Silfverskiöld test(<5° of dorsiflexion with the knee extended that improves to >10° with the knee flexed)

Gastocnemius Recession Technique

  • Prone
  • Gastrocnemius and soleus fascial layers separated just distal to the gastrocnemius muscle-fascia confluence
  • Gastrocnemius fascia is sectioned just distal to the musculotendinous junction to minimize disruption to the soleus fascia and muscle. 
  • Proximal gastrocnemius tendon is sutured back to the underlying soleus fascia.

Gastocnemius Recession Complications

Gastocnemius Recession Follow-up care

  • Post-op:immobilized in a short leg plaster cast and partial weight-bearing was permitted
  • 7-10 Days: walking boot, WBAT. rm Achilles tendon and gastrocnemius-stretching exercises and ankle motion exercises twice a day.
  • 3 Weeks:home program including elastic-band ankle and foot-strengthening and heel-raising exercises.  May start low-impact exercise, including swimming, biking, and elliptical training.
  • 6 Weeks: gradually advance to full activities without restriction, with gradual resumption of low-impact weight-bearing activities

Gastocnemius Recession Outcomes

  • 85% of Achilles tendinopathy patients are satisfied with outcome.  May have gastroc weakness.  (Nawaczenski DA, J Bone Joint Surg Am, 2015 Jan 21;97(2):99-105)

Gastocnemius Recession Review References

  • Nawoczenski, J Bone Joint Surg Am, 2015 Jan 21;97(2):99.
  • Duthon VB, Lübbeke A, Duc SR, Stern R, Assal M. Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening. Foot Ankle Int. 2011 Apr;32(4):375-9. 
  • Kiewiet NJ, Holthusen SM, Bohay DR, Anderson JG. Gastrocnemius recession for chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2013 Apr;34(4):481-5. Epub 2013 Feb 11. 
  • Chimera NJ, Castro M, Davis I, Manal K. The effect of isolated gastrocnemius contracture and gastrocnemius recession on lower extremity kinematics and kinetics during stance. Clin Biomech (Bristol, Avon). 2012 Nov;27(9):917-23. Epub 2012 Jul 20 
  • Sammarco GJ, Bagwe MR, Sammarco VJ, Magur EG. The effects of unilateral gastrocsoleus recession. Foot Ankle Int. 2006 Jul;27(7):508-11.z

 

 

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