ROLE AND OUTCOME OF GASTROCNEMIUS

RECESSION IN TIBIAL LENGTHENING

Savanaranaraja Muthusamy, MBBS, MS

Samuel Zonshayn, MS II

Eugene W. Borst, BA

Austin T. Fragomen, MD

S. Robert Rozbruch, MD

Limb Lengthening & Complex Reconstruction Service.

Hospital For Special Surgery, New York.

Disclaimer

The following authors have no financial disclosures:

Savanaranaraja Muthusamy, MBBS, MS

Samuel Zonshayn, MS II

Eugene W. Borst, BA

The following authors receive royalty from Small Bone

Innovations and are consultants for Smith and Nephew.

Austin T. Fragomen, MD

S. Robert Rozbruch, MD

Introduction

Tibia lengthening is frequently associated with

Gastrocnemius contracture. Some patients do

and some patients do not need a Gastrocnemius

Recession (GR).

We performed a retrospective case matched

comparison study to find out:

Questions

1. What are the risk factors that lead to the need

for GR?

Questions

1. What are the risk factors that lead to the need

for GR?

2. What are the indications for GR during tibia

lengthening?

Questions

1. What are the risk factors that lead to the need

for GR?

2. What are the indications for GR during tibia

lengthening?

3. What is the outcome after GR?

MATERIALS AND METHODS

Demographics

Group A (GR) Group B (No

GR)

P Value

Number of

patients

41 41 N/A

Number of Tibia

Lengthening

55 50 N/A

Age (Yrs) 33 28 0.178

Preop Tibial

Length (mm)

333 342 0.414

Time in Frame

(Months)

4 4 0.508

Timing / Indication - GR

Timing Indication Pre GR Equines

Contracture –

Average in degrees.

At frame application Preoperative

Contracture

2.5

While in frame Recalcitrant

Contracture

20

At frame removal Recalcitrant

Contracture

15

After frame removal Recalcitrant

Contracture

9

Physical Therapy

All the patients underwent

aggressive PT with tibia

lengthening to prevent

equines contracture.

Surgical Technique

Surgical Technique

Surgical Technique

Surgical Technique

Surgical Technique

We administered a self reported outcome

questionnaire.

RESULTS

Etiology: (Congenital - p value - 0.032)

0

10

20

30

40

50

60

70

Congen Develop Traumatic

GR %

No GR %

Results

Group A

(GR)

Group B (No

GR)

P Value

Amount of

lengthening

(mm)

49 (24 – 82)

35 (8 – 75)

<0.001

Results

Group A

(GR)

Group B (No

GR)

P Value

Amount of

lengthening

(mm)

49 (24 – 82)

35 (8 – 75)

<0.001

% of

Lengthening 15

(7 – 46)

11 (2 – 29)

0.002

Length of follow up.

Length of the follow up

Average – 66 months

Range – 11 to 156 months

Ankle DF gained after GR

Timing Indication Pre GR

Equines

Final DF DF gained P Value

At frame

application

Preop

Contracture

2.5 3.5 11 0.082

While in

frame

Recalcitrant

Contracture

20 6 26 <0.001

At frame

removal

Recalcitrant

Contracture

15 12 26 <0.001

After frame

removal

Recalcitrant

Contracture

9 5 14 0.005

Ankle DF gained after GR

Pre GR

Equines

Final DF

DF gained

P Value

All 4

groups

combined

13

8

23.5

<0.001

Ankle DF (All 4 groups combined)

Group A (GR)

Group B (No GR)

Pre tibia

lengthening 8 14

F/U 8

(After GR)

10

P Value 0.573 0.002

ROC Curve for Threshold Value

Before GR

Before GR

Before GR

After GR

After GR

Self reported outcome questionnaire (Excluding group 1)

Question Group A

(GR)

Group B

(No GR)

P value

Ability to toe off on both feet 96.7% 91.7% 0.579

Ability to toe off on one foot 82.8% 87.5% 0.715

Ability to run 85.2% 85.2% 0.999

Presence of limp 21.4% 24% 0.823

Necessity for assistance to walk 3.6% 16% 0.176

Weakness of ankle compared to

before tibia lengthening

28.6% 16.7% 0.346

Stiffness of ankle compared to

before tibia lengthening

34.6% 33.3% 0.924

Conclusion

Risk factors that led to need for GR

Amount of lengthening - 42 mm (Threshold value)

Percent of lengthening - 13% (Threshold value)

Congenital etiology

Conclusion

Outcome

There was substantial gain in ankle DF after GR.

Conclusion

Outcome

There was substantial gain in ankle DF after GR.

There were no significant differences in the self-

reported outcomes between groups A and B in

regards to functional outcome after GR.

Conclusion

Outcome

There was substantial gain in ankle DF after GR.

There were no significant differences in the self-

reported outcomes between groups A and B in

regards to functional outcome after GR.

With the regular use of GR in selected patients with

equines contracture during tibial lengthening,

satisfactory and uniform outcomes were achieved.

THANK YOU