Results of Proximal Medial Gastrocnemius Release for Achilles Tendinopathy

Abstract

Background: Most patients with Achilles tendinopathy (AT) are treated successfully with physiotherapy involving eccentric calf training. In some patients, gastrocnemius contracture persists and there are reports of improvement following gastrocnemius release. We present the first series of patients to have proximal medial gastrocnemius release (PMGR) for AT. Method: 16 PMGRs (12 patients) were performed at our institution over a 2-year period. Nine patients (10 PMGRs) were available for follow-up. The mean age of patients was 45 years (range, 25-63 years), with 5 female and 4 male subjects. The average follow-up period was 2.5 years (range, 1.7-3.3 years). The sample was divided into noninsertional and insertional tendinopathy, with 5 PMGRs per group. Outcome measures were visual analog scale (VAS) scores, Victorian Institute of Sport Assessment–Achilles (VISA-A) scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and overall satisfaction. Complications and further procedures were also recorded. Results: At an average of 2.5 years of follow-up, 6 out of 9 patients were highly satisfied. The noninsertional tendinopathy group enjoyed better results than the insertional group: mean VISA-A scores improved by 59% (noninsertional) versus 22% (insertional); mean AOFAS scores improved by 29% (noninsertional) versus 15% (insertional). The improvement in the noninsertional group was statistically significant ( P < .05) for all 3 outcome measures. Conclusion: PMGR was an outpatient procedure that was well tolerated without wound healing concerns due to the proximally based incision. Patients with noninsertional tendinopathy who have failed conservative treatment can expect notable improvement, with VISA-A scores possibly normalizing after the procedure. We recommend PMGR for patients suffering recalcitrant noninsertional AT in whom gastrocnemius contracture persists despite an eccentric stretching program. Level of Evidence: Level IV, case series.