title: Gastrocsoleus recession techniques: an anatomical and biomechanical study in human cadavers.
abstract: Lengthening of the conjoined tendon of the gastrocnemius aponeurosis and soleus fascia is frequently used in the treatment of equinus deformities in children and adults. The Vulpius procedure as described in most orthopaedic texts is a division of the conjoined tendon in the shape of an inverted V. However, transverse division was also described by Vulpius and Stoffel, and has been reported in some clinical studies. We studied the anatomy and biomechanics of transverse division of the conjoined tendon in 12 human cadavers (24 legs). Transverse division of the conjoined tendon resulted in predictable, controlled lengthening of the gastrocsoleus muscle-tendon unit. The lengthening achieved was dependent both on the level of the cut in the conjoined tendon and division of the midline raphé. Division at a proximal level resulted in a mean lengthening of 15.2 mm (sd 2.0, (12 to 19), which increased to 17.1 mm (sd 1.8, (14 to 20) after division of the midline raphé. Division at a distal level resulted in a mean lengthening of 21.0 mm (sd 2.0, (18 to 25), which increased to 26.4 mm (sd 1.4, (24 to 29) after division of the raphé. These differences were significant (p < 0.001).
authors.affiliation: The University of Melbourne, Department of Paediatrics, Flemington Road, Parkville, Victoria 3052, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Tinney
authors.affiliation: The Royal Children's Hospital, Department of Orthopaedics, Flemington Road, Parkville, Victoria 3052, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Khot
authors.affiliation: Monash University, Department of Anatomy and Developmental Biology, Clayton, Victoria, 3168, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Eizenberg
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria 3168, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: The University of Melbourne, Department of Orthopaedics, Royal Children's Hospital, Murdoch Childrens Research Institute, University of Melbourne, Flemington Rd, Parkville, Victoria, 3052, Australia.
authors.forename: H K
authors.initials: HK
authors.lastname: Graham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D002547:Cerebral Palsy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000601:surgery*; D012680:Sensitivity and Specificity; D013035:Spasm / Q000601:surgery; D013710:Tendons / Q000503:physiopathology / Q000601:surgery; D058971:Tenotomy / Q000379:methods*
keywords: Cerebral palsy; Contracture; Equinus; Gastrocsoleus; Human Cadaver; Muscle recession