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      A Novel Surgical Technique for the Reconstruction of Chronic Tennis Leg Injury

      case-report
      1 , , 1 , 1 , 1 , 1
      ,
      Cureus
      Cureus
      operative treatment, chronic, rupture, medial gastrocnemius, tennis leg

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          Abstract

          Tennis leg, a rupture of the medial head of the gastrocnemius muscle at the musculotendinous junction (MTJ), is common, particularly among middle-aged sports enthusiasts. While acute cases usually resolve with conservative care, optimal surgical strategies for the treatment of chronic injuries remain undefined. This study reviews the current literature and details the successful operative treatment of a 37-year-old male with a 12-month history of tennis leg, employing a novel reverse flap technique from the MTJ's aponeurosis and augmented by a facia lata allograft.

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          Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US.

          To evaluate the ultrasonographic (US) findings in patients with a referring diagnosis of tennis leg and to explore the relative importance of the plantaris tendon and gastrocnemius muscle in the pathogenesis of this condition. A cadaveric study was performed to outline the normal anatomy of the posterosuperficial compartment of the calf. Magnetic resonance (MR) imaging and US were performed, followed by gross anatomic correlation. US findings in 141 patients referred with a clinical diagnosis of tennis leg were retrospectively reviewed by means of consensus of two radiologists. Images were analyzed with respect to the integrity of the lower-leg musculotendinous units, presence of fluid collection, and deep venous thrombosis. MR imaging and US enabled distinction of the musculotendinous unit of the plantaris from the remaining muscles of the lower extremity in cadaveric specimens. US findings in the 141 patients included rupture of the medial head of the gastrocnemius muscle in 94 patients (66.7%), fluid collection between the aponeuroses of the medial gastrocnemius and soleus muscles without muscle rupture in 30 patients (21.3%), rupture of the plantaris tendon in two patients (1.4%), and partial rupture of the soleus muscle in one patient (0.7%). Deep venous thrombosis was seen in isolation in 14 patients (9.9%). In patients with clinical findings of tennis leg who undergo US, abnormalities of the medial gastrocnemius muscle appear to be more common than those of the plantaris tendon.
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            Ruptures of the medial head of the gastrocnemius ("tennis leg"): clinical outcome and compression effect.

            The purpose of this study is to describe the clinical outcome of conservative treatment in patients with rupture of the medial head of the gastrocnemius ("tennis leg") occurring during exercise and training and the effect of the compression treatment. Thirty patients (conservative treatment=15; compression treatment=15), aged 30-45 years, with clinically suspected rupture of the medial head of the gastrocnemius occurring during exercise and training were referred for ultrasonography (US) examination. All patients underwent US of the affected and contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients each were performed at 1-week intervals during the month after injury and at 2-week intervals during the following 6 months. US findings were analyzed with respect to the integrity of the musculotendinous junctions of the gastrocnemius, the presence of a fluid collection, and the union time of the medial head of the gastrocnemius with the soleus muscle. In addition, we analyzed the clinical outcome of the compression treatment. Of the 30 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in 11 patients (36.7%); the remaining 19 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 25 patients (83.3%). First union of the medial head of the gastrocnemius with the soleus muscle in the compressive group was significantly rapid than that of the conservative group (4.25 vs. 3.25 weeks; P=.02). Fluid collection between the two muscles after 1 month in the compressive group was significantly smaller than that in the conservative group (8.9 vs. 4.5 mm; P=.01). Early compressive treatment in patients with rupture of the medial head of the gastrocnemius decreases the hemorrhage amount and can be possible for early ambulation.
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              Surgical treatment of gastrocnemius muscle ruptures.

              Rupture of the medial head of the gastrocnemius, known as "tennis leg", typically occurs when the muscle has been overstretched by dorsiflexion of the ankle with full knee extension. The classic clinical presentation is a middle-aged person who complains of sports-related acute pain in the mid portion of the calf, associated with a snapping sensation. Magnetic resonance imaging (MRI) or ultrasound is often required to evaluate patients with this condition. This injury is usually managed non-operatively, surgical treatment rarely being indicated according to published reports. One case of longstanding and one of recent rupture of the musculotendinous junction of the medial head of the gastrocnemius that were successfully treated by surgical repair are presented here and the MRI characteristics and indications for surgery are discussed.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                9 February 2024
                February 2024
                : 16
                : 2
                : e53943
                Affiliations
                [1 ] First Orthopaedic Department of Aristotle University of Thessaloniki, "Georgios Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
                Author notes
                Nikolaos Platon Sachinis nick.sachinis@ 123456gmail.com
                Article
                10.7759/cureus.53943
                10925895
                38469006
                f2cff573-03b5-4c11-b967-4e750b2efcba
                Copyright © 2024, Sachinis et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 February 2024
                Categories
                Orthopedics
                Trauma
                Sports Medicine

                operative treatment,chronic,rupture,medial gastrocnemius,tennis leg

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