Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients.

BACKGROUND: Gastrocnemius recession has become a popular procedure to treat the equinus ankle caused by a tight gastrocnemius. The aim of our study was to prospectively evaluate the safety and efficacy of the endoscopic gastrocnemius recession procedure using a single portal technique. METHODS: The endoscopic gastrocnemius recession procedure was performed on 56 feet in 54 consecutive patients through a single lateral portal using the Smart Release Endoscopic Carpal Tunnel Release System. The minimum follow-up was 12 months. Functional outcomes were assessed with the Short Form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O&M) score. A modified Likert scale and visual analogue scores (VAS) were used to evaluate patient satisfaction and pain scores, respectively. Postoperative morbidities were documented for wound complications, scar hypersensitivity, sural nerve deficit and plantar flexion weakness. A p-value <0.05 was considered statistically significant. RESULTS: Endoscopic gastrocnemius recession procedure performed through a single lateral portal was successfully performed in all cases. Seven out of the eight component scores of the SF-36 questionnaire showed significant improvements. The AOFAS Hindfoot score showed a significant improvement of 20.69 ± 19.20. The modified O&M score also revealed significant improvements in eight out of nine component scores. There was a significant improvement of 3.79 ± 2.49 in VAS scores. A total of 91.07 % of all cases reported good or very good outcomes on the Likert scale. Eleven complications were recorded (three cases of unsatisfactory operative scar, three cases of sural nerve dysesthesia and five cases of subjective plantar flexion weakness with complete resolution in two out of the five patients.). CONCLUSION: This study demonstrates that the endoscopic gastrocnemius recession procedure performed through a single portal technique has low morbidity with good to excellent results. LEVEL OF EVIDENCE: Level III, retrospective study.

Central calcaneal osteotomy for correction of flexible pes planovalgus deformity.

BACKGROUND: Lateral column lengthening procedures have been extensively reported either as primary procedures or adjuncts to combined soft tissue procedures and osteotomies for the correction of the pes planovalgus deformity. There is also considerable debate as to the ideal procedure that is not followed by recurrence and obviates the need for revision surgeries and minimizes complications. We describe a technique and present the clinical results of lateral column lengthening that provides a powerful correction to restore normal foot alignment. METHODS: We retrospectively reviewed 26 feet in 21 patients with a mean age of 35.4 years (range, 12-75) over an average follow-up period of 71 months (range, 12-147) who underwent reconstructive surgery for flexible pes planovalgus foot. The reconstructive procedures included a central calcaneal osteotomy in all patients, a medial column stabilization procedure, flexor digitorium transfer (FDL), and a gastrocnemius or Achilles tendon lengthening. Clinical evaluation was carried out with the AOFAS ankle-hindfoot scores. Standard weight-bearing anterior posterior (AP) and lateral radiographs before surgery and at follow-up were analyzed for radiographic parameters of correction. RESULTS: The median AOFAS score increased from 50 to 90. Two patients reported dissatisfaction with the result. There were no nonunions nor complications related to hardware. Radiographic improvement of the talonavicular coverage angle was a 74% change from baseline value. All radiographic parameters improved (P < .001) except the lateral talocalcaneal angle (P = .48). No secondary subsidence of the arch was observed within the follow-up time. CONCLUSION: Correction of flexible pes planovalgus deformity with a central calcaneal osteotomy was an effective, reproducible method to restore normal foot alignment and good function. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Total hip arthroplasty for ankylosed hip secondary to heterotopic ossification.

Heterotopic ossification (HO) secondary to traumatic brain injury occurs at various sites and most commonly at the elbow, shoulder, and hip. There are few published reports on the assessment and surgical resection techniques of HO. A complete preoperative physical examination and radiologic assessment with a computed tomographic scan are important for the thorough evaluation of a patient. We describe a patient with neurogenic HO of the hip secondary to traumatic brain injury who underwent a total hip arthroplasty (THA). In selected patients with hip HO, THA supplemented with postoperative radiotherapy and indomethacin prophylaxis can facilitate progressive functional movements of the hip. To our knowledge, there is no report in the English literature of a THA being preformed for HO.