Proximal vs. Distal Gastrocnemius Recession: A Side-to-Side Comparison in Full-Body Cadaveric Specimens

Michael Michlin, Panagiotis Symeonidis, Leda Kovatsi, Trifon Totlis

Introduction: Gastrocnemius tightness contributes to various foot and ankle pathologies. While both Proximal Medial Gastrocnemius Release (PMGR) and the Strayer procedure are widely used, comparative data on their biomechanical effects are limited, particularly within the same specimen. This study aimed to compare dorsiflexion improvement between PMGR and Strayer procedures using a side-to-side cadaveric model.

Method: A total of 15 fresh-frozen full-body cadaver specimens were included after screening 17 for eligibility. Each specimen underwent a randomized side-to-side comparison: one leg received PMGR and the other the Strayer procedure. Passive ankle dorsiflexion was measured before and after intervention using a standardized 10 kg applied force and electronic goniometer. Relative change in dorsiflexion was also calculated. All procedures were performed by a single orthopaedic surgeon; measurements were performed by a blinded observer.

Results: Baseline dorsiflexion was similar between limbs (PMGR: median -18.5°; Strayer: -19.0°, p=0.776). Postoperatively, the Strayer procedure resulted in significantly greater dorsiflexion (median -3.4° vs. -9.0°, p<0.001). Absolute dorsiflexion gain was higher in the Strayer group (median 14.7° vs. 8.0°, p=0.001), as was relative improvement (14.9% vs. 7.4%, p<0.001). No correlation was found between improvement and age, sex, or BMI.

Conclusion: Distal gastrocnemius recession (Strayer) resulted in significantly greater dorsiflexion gain compared to proximal release (PMGR) within the same specimen. While more distal procedures may yield superior biomechanical correction, clinical decision-making should also consider potential risks such as sural nerve injury and soleus involvement.