Abstract
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 jum** sports. Patients present with a chief complaint of acute pain in the calf, variably associated with a “snap**/pop**” 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.
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References
Powell RM. Lawn tennis leg. Lancet. 1883;2:44.
Arner O, Lindholm A. What is tennis leg? Acta Chir Scand. 1958;116:73–7.
Delgado GJ, Chung CB, Lektrakul N, et al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology. 2002;224(1):112–9.
Garrett WE Jr, Nikolaou PK, Ribbeck BM, Glisson RR, Seaber AV. The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. Am J Sports Med. 1988;16(1):7–12.
Millar AP. Strains of the posterior calf musculature (“tennis leg”). Am J Sports Med. 1979;7(3):172–4.
McClure JG. Gastrocnemius musculotendinous rupture: a condition confused with thrombophlebitis. South Med J. 1984;77(9):1143–5.
Froimson A. Tennis leg. JAMA. 1969;209:415–6.
Dürig M, Schuppisser JP, Gauer EF, Müller W. Spontaneous rupture of the gastrocnemius muscle. Injury. 1977;9(2):143–5.
Chagou A, Benameur H, Zine A, Bouabid S, Boussougua M, Jaafar A. Compartment syndrome complicating tennis leg: about a case. Pan Afr Med J. 2020;37:310.
Jarolem KL, Wolinsky PR, Savenor A, Ben-Yishay A. Tennis leg leading to acute compartment syndrome. Orthopedics. 1994;17(8):721–3.
Tao L, Jun H, Muliang D, Deye S, Jiangdong N. Acute compartment syndrome after gastrocnemius rupture (tennis leg) in a nonathlete without trauma. J Foot Ankle Surg. 2016;55(2):303–5.
Straehley D, Jones WW. Acute compartment syndrome (anterior, lateral, and superficial posterior) following tear of the medial head of the gastrocnemius muscle. A case report. Am J Sports Med. 1986;14(1):96–9.
Anouchi YS, Parker RD, Seitz WH Jr. Posterior compartment syndrome of the calf resulting from misdiagnosis of a rupture of the medial head of the gastrocnemius. J Trauma. 1987;27(6):678–80.
Flecca D, Tomei A, Ravazzolo N, Martinelli M, Giovagnorio F. US evaluation and diagnosis of rupture of the medial head of the gastrocnemius (tennis leg). J Ultrasound. 2007;10(4):194–8.
Bianchi S, Martinoli C, Abdelwahab IF, Derchi LE, Damiani S. Sonographic evaluation of tears of the gastrocnemius medial head (“tennis leg”). J Ultrasound Med. 1998;17(3):157–62.
Monseau AJ, Balcik BJ, Denne N, Sharon MJ, Minardi JJ. Point-of-care ultrasound diagnosis of tennis leg. Clin Pract Cases Emerg Med. 2019;3(1):36–9.
Menz MJ, Lucas GL. Magnetic resonance imaging of a rupture of the medial head of the gastrocnemius muscle. A case report. J Bone Joint Surg Am. 1991;73(8):1260–2.
Kwak HS, Lee KB, Han YM. Ruptures of the medial head of the gastrocnemius (“tennis leg”): clinical outcome and compression effect. Clin Imaging. 2006;30(1):48–53.
Domeracki SJ, Landman Z, Blanc PD, Guntur S. Off the courts: occupational “tennis leg”. Workplace Health Saf. 2019;67(1):5–8.
Jennings A, Peterson R. Delayed reconstruction of medial head of gastrocnemius rupture: a surgical option. Foot Ankle Int. 2013;34(6):904–7.
Cheng Y, Yang HL, Sun ZY, Ni L, Zhang HT. Surgical treatment of gastrocnemius muscle ruptures. Orthop Surg. 2012;4(4):253–7.
Campbell JT. Posterior calf injury. Foot Ankle Clin. 2009;14(4):761–71.
Shields CL Jr, Redix L, Brewster CE. Acute tears of the medial head of the gastrocnemius. Foot Ankle. 1985;5(4):186–90.
Ryu DJ, Kim JM, Kim BS. Concomitant contracture of the knee and ankle joint after gastrocnemius muscle rupture: a case report. J Foot Ankle Surg. 2017;56(1):87–91.
Takigami J, Hashimoto Y, Yamasaki S, Hara Y, Nishikino S, Nakamura H. Gastrocnemius contracture caused by traumatic injury without fracture: a case report. Foot Ankle Int. 2011;32(12):1152–4.
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Fletcher, A.N., Adams, S.B. (2023). Ruptures of the Medial Gastrocnemius Tendon (“Tennis Leg”). In: Adams, S.B. (eds) The Achilles Tendon. Springer, Cham. https://doi.org/10.1007/978-3-031-45594-0_6
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