Dual-portal endoscopic gastrocnemius recession for the treatment of severe posttraumatic equinus deformity: a case series and a review of technical modifications.
OBJECTIVE
Several authors have recently reported the benefits of endoscopic gastrocnemius recession (EGR) for the treatment of nontraumatic equinus contracture. However, little is known about its potential for correcting severe posttraumatic equinus contracture. This study aimed to evaluate the effectiveness of dual-portal EGR in patients with severe, intractable equinus following severe trauma to the leg and foot. The recent technique of EGR with supplemental modified procedures was reviewed to improve its capability for correcting deformities and to provide information to avoid complications.


METHODS
The subjects were 4 patients with intractable, progressive, severe posttraumatic soft-tissue equinus contractures after at least 3 months of unsuccessful conservative treatment. The exclusion criteria were spastic contracture, including osseous equinus. One patient with gastrocnemius equinus underwent EGR alone as a straightforward correction. Three patients with gastrocnemius-soleus equinus underwent EGR to correct the gastrocnemius component followed by a modified percutaneous tendo-Achilles lengthening (TAL) procedure to correct any residual deformities. All data of the preoperative period and each successive postoperative period (1, 3, and 6-12 months) were prospectively collected and included the degree of ankle dorsiflexion, American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale score, the Visual Analogue Scale-Foot and Ankle (VAS-FA) score, and any related complications. Intraoperatively, the degree of ankle-dorsiflexion was recorded immediately following each procedure.


RESULTS
The mean increase in intraoperative dorsiflexion was 35° ± 9.1° (range: 25°-45°) in all 4 patients and 21.7° ± 10.4° (range, 10°-30°) in the 3 patients undergoing EGR and modified TAL, respectively. There were significant differences in the improvements (p<0.05) in the preoperative period and each successive postoperative period in the increased values of ankle dorsiflexion, AOFAS scores, and VAS-FA scores. There were no significant iatrogenic complications.


CONCLUSIONS
Intractable, severe posttraumatic equinus is not commonly encountered by orthopaedic surgeons. Despite the rarity of this condition, which is responsible for the limited number of patients in this series, our results indicates that dual-portal EGR, with or without modified TAL, is a promising treatment, with satisfactory effectiveness and lower risks of complications, for correcting this problematic deformity.
Foot and Ankle Surgery, Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. chatthara@yahoo.com
Chayanin
C
Angthong
Supakit
S
Kanitnate
D000328:Adult; D004724:Endoscopy / Q000379:methods*; D004863:Equinus Deformity / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D011182:Postoperative Care; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult