Authors:
Benjiman J. Wilebski, M.D., A.T.C., Luke V. Tollefson, B.S., Dustin R. Lee, M.D., Matthew T. Rasmussen, M.D., and Robert F. LaPrade, M.D., Ph.D.
Abstract:
The medial gastrocnemius tendon’s (MGT) primary role is to perform plantarflexion of the foot. It attaches to the gastrocnemius tubercle, one of the primary medial femoral osseous landmarks. Injury to the musculotendinous junction of the MGT often is referred to in the literature as “tennis leg” syndrome because of the classic acute onset of pain while participating in such sports. Tendon avulsions of the medial gastrocnemius occur less frequently, and documentation is limited as injuries typically occur at the musculotendinous junction. Conservative treatment typically is recommended for MGT avulsion injuries unless patient function continues to be limited, and then surgical intervention is considered. This technique describes an anatomic repair of a proximal avulsion tear of the medial gastrocnemius tendon in the setting of a chronic injury.
Video Summary:
This video demonstrates an arthroscopically assisted anatomic repair of a medial gastrocnemius proximal tendon avulsion. The patient is placed supine under general anesthesia, and a medial knee incision is made to expose key anatomical landmarks. The scarred proximal attachment of the medial gastrocnemius tendon is detached, prepared, and its anatomic insertion site on the femur identified. Two double-loaded suture anchors are placed at this site, and the tendon is whip-stitched after removing scar tissue.
Tension testing with knee motion and foot dorsiflexion ensures proper anatomic positioning and prevents overtightening. Arthroscopy confirms normal joint structures and visualizes the sutures reducing the tendon to its footprint. With the knee at 20° flexion, sutures are tied to achieve firm fixation. The tendon is shown to tighten appropriately in extension and dorsiflexion, confirming a stable, anatomic repair.
