Ruptures of the Medial Gastrocnemius Tendon ("Tennis Leg")
Tennis leg refers to a partial or complete tear of the medial head of the gastrocnemius, occurring most commonly at the musculotendinous junction. The gastrocnemius spans three joints (knee, tibiotalar, and subtalar) and is subjected to excessive stretch and is thus vulnerable to injury. The mechanism of injury involves concomitant knee extension and ankle dorsiflexion. Risk factors include middle age, male gender, and participation in running and jumping sports. Patients present with a chief complaint of acute pain in the calf, variably associated with a "snapping/popping" sound or sensation. Clinical findings can include calf swelling, tenderness, ecchymosis over the middle third of the medial calf, a plantarflexed ankle, and painful or weak ankle dorsiflexion. The history and clinical examination are often sufficient to diagnose tennis leg; however, ultrasound or magnetic resonance imaging should be utilized to confirm the diagnosis and exclude other potential pathologies. Compartment syndrome and deep venous thrombosis may be differential diagnoses or concomitant pathologies and should be ruled out. The majority of tennis leg injuries are successfully managed with conservative management, directed at limiting hemorrhage and pain with activity modification, ice, compression, elevation, nonsteroidal anti-inflammatories, a heel lift, and early physical therapy. Prolonged immobilization should be avoided. Operative repair of the medial head of the gastrocnemius is rare and is reserved for patients with symptoms refractory to nonoperative measures. The prognosis is positive with the majority of patients returning to their baseline level of physical activity around 6 weeks with no clinical deficits in plantarflexion and a very low reoccurrence rate.
