Sural nerve injury risk during endoscopic gastrocnemius recession: Comparison of two approaches

Napiontek W.; Oliva X.M.; Cárcamo-Aguilar F.; Belling D.A.; Zárate Leal M.F.; Diaz Sanchez T. · Foot and Ankle Surgery (2025) · DOI: 10.1016/j.fas.2025.03.003

Resumen

Backgrounds: The gastrocnemius recession was originally introduced as a method of treating isolated gastrocnemius contractures among pediatric population, however currently this procedure allows to treat various foot pathologies. Different modifications of open technique has been developed over the years and recently endoscopic approach become a widespread technique among many surgeons. It provides smaller incision and shorter operative time, however might be associated with the higher risk of sural nerve damage as a result of poor visualization. The aim of this study was to evaluate two different endoscopic approaches, introduced by Stryer and Lui, in terms of sural nerve injury. Method: In 14 dissected legs the following measurements were assessed: 1) Distance between the sural nerve and cannula. 2) Distance to the sural nerve from the lateral portal and the medial portal when performing the Strayer technique. 3) Distance to the sural nerve from the lateral portal and the medial portal when performing the Lui technique. Result: In both techniques the sural nerve was located dorsally to the cannula and no nerve damage was observed. In Lui technique the distance between cannula and the nerve was noticeably deeper than in Strayer method. Conclusion: Both method of endoscopic gastrocnemius recession have similar risk of intraoperative sural nerve injury. Open method should always be considered as an alternative, especially for surgeons who lack experience in endoscopic procedures. Level of evidence: II