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A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions

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Open AccessCase Report A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions by Stefania Pinna Stefania Pinna SciProfiles Scilit Preprints.org Google Scholar *, Simone Perfetti Simone Perfetti SciProfiles Scilit Preprints.org Google Scholar , Matteo Di Benedetto Matteo Di Benedetto SciProfiles Scilit Preprints.org Google Scholar and Giuseppe Spinella Giuseppe Spinella SciProfiles Scilit Preprints.org Google Scholar Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, Ozzano dell’Emilia, 40064 Bologna, Italy * Author to whom correspondence should be addressed. Animals 2026, 16(12), 1783; https://doi.org/10.3390/ani16121783 (registering DOI) Submission received: 30 April 2026 / Revised: 6 June 2026 / Accepted: 8 June 2026 / Published: 9 June 2026 Simple Summary Injuries of the gastrocnemius muscle and the common calcaneal tendon are relatively common in dogs and can significantly compromise limb function. Stabilization of the tarsal joint is essential to protect the injured structures during healing; however, traditional methods often involve external fixation or rigid implants which may be associated with complications. This study described a minimally invasive internal stabilization technique using synthetic tape placed between the tibia and the calcaneus in two dogs with gastrocnemius myotendinous injuries. Both dogs showed progressive recovery with restoration of limb function. In these two dogs, no major complications were observed during the 5–9-month follow-up period. This technique may represent a promising option for selected cases; however, additional studies are needed to confirm its effectiveness and potential advantages as compared with established methods. Abstract Injuries of the gastrocnemius muscle and the common calcaneal tendon in dogs require effective stabilization of the tarsocrural joint to allow proper healing and prevent mechanical overload. This report described a novel minimally invasive technique for temporary internal tarsal stabilization using synthetic tape in two dogs. No comparison with other stabilization techniques was carried out. Both dogs presented with hindlimb lameness and partial plantigrade stance secondary to a subtotal injury of the lateral myotendinous gastrocnemius, and were treated without primary tenorrhaphy. Internal stabilization was achieved by placing polypropylene tape (Bühner’s tape) between the tibial tuberosity and the calcaneus, acting as a flexion-limiting device. A clinical, radiographic, and ultrasonographic follow-up was carried out for 5–9 months. Both dogs showed progressive clinical improvement with restoration of near-normal tarsal angles. Ultrasonography demonstrated progressive healing with fibrous tissue bridging the myotendinous junction. No major complications or radiographic signs of osteoarthrosis were observed. This technique may represent a promising option for selected cases; however, additional studies are needed to compare it with established external or rigid internal fixation methods. Keywords: gastrocnemius muscle; internal stabilization; dog 1. Introduction Several methods of classifying muscle and tendon injuries have been proposed in human medicine [ 5]. However, in 1993, Meutstege reported a specific classification of lesions involving the canine Achilles tendon [ 6] and described three typologies of lesions: Type 1 characterized by a total rupture (and/or avulsion) and plantigrade stance, Type 2 (with three sub-types) united by the appearance of a mild to moderate flexion of the hock (“dropped hock”) during weight bearing, and Type 3 with limitation of a fully extended stifle and flexion of the hock [ 6]. Classifying an injury is useful not just to understand its severity and tissue involvement, but also to give a reliable prognosis to the owner. Furthermore, the involvement of different components (tendon, muscle-tendon junction, muscle belly, muscle fascia) could influence the therapeutic approach which has to ensure an appropriate movement limitation in order to provide proper and effective healing. To the Authors’ knowledge, the use of internal tape-based stabilization between the tibia and calcaneus for temporary tarsocrural immobilization in dogs has not previously been described in veterinary literature. This technique could provide immobilization of the joint with minimal surgical trauma of the soft tissue and limited impact on joint mobility during follow-up. The aim of this case report was to describe the surgical technique of tape application for temporary internal immobilization of the tarsocrural joint and to report the clinical and ultrasonographic outcomes in two dogs with partial myotendinous lesions (type 2 according to Meutstege’s classification). It has been hypothesized that tape application, acting as a flexion limiter, could reduce mechanical stress on the injured area and thereby support healing during the recovery period. 2. Materials and Methods Two dogs were presented for clinical evaluation following traumatic injury. Both dogs exhibited lameness associated with a mild unilateral plantigrade stance. The diagnostic workup included an orthopedic examination as well as radiographic and ultrasonographic evaluations. Measurement of the “dropped hock” was carried out with the dogs standing in lateral view using a plastic goniometer; this was compared with that of the contralateral limb. To ensure weight bearing on the limb being examined, the contralateral limb was elevated from the ground. The tarsal descent angle (TDA) was measured as the angle between a line drawn perpendicular to the ground and touching the caudal aspect of the calcaneus, and a line aligned with the caudal aspect of the metatarsus. The standing tarsal joint angle (TJA) was also recorded ( Figure 1). The MSK ultrasound examinations were carried out using the same device (Philips EPIQ 5, Philips UK Ltd., Guildford, UK) equipped with a 5–12 MHz linear transducer. All the ultrasound examinations were independently carried out by a sonographer with at least 5 years of experience in musculoskeletal ultrasound. All the examinations were carried out while the patient was awake using a manual restraint. The region of interest was assessed in both transverse and longitudinal planes, adjusting the probe angulation according to the musculoskeletal structure being examined. These two dogs met the inclusion criteria which were considered suitable for the application of this novel surgical technique. The inclusion criteria were adult dogs, companion animals instead of working dogs, acute traumatic injury, the presence of a “dropped hock” or mild-moderate plantigrade stance, and partial myotendinous injury of the gastrocnemius muscle with preserved continuity of the CCT. The exclusion criteria were complete rupture of the CCT, severe tarsal instability, associated fracture, and concurrent orthopedic conditions, such as cranial cruciate ligament rupture, patellar luxation, or angular limb deformities. 2.1. Case Presentation 2.1.1. Case 1 A 9-year-old spayed female Shiba Inu, weighing 16 kg, was presented with grade 2/4 lameness of the left hindlimb which had occurred after jumping while playing four days earlier. The dog showed a plantigrade stance with the hock mildly hyperflexed (“dropped hock”). The orthopedic examination revealed pain on palpation of the caudal crus as well as slight swelling at the musculotendinous junction of the gastrocnemius muscle and along the length of the CCT. Mediolateral and dorsoplantar radiographic evaluation of the affected limb was carried out. No signs of osteoarthrosis, joint effusion, fracture, avulsion or fabellar displacement were observed. An ultrasound examination was carried out for evaluation of muscle-tendon structures from the stifle to the hock. Common calcaneal tendon examination, carried out using longitudinal and transverse scans, showed a mild effusion of the tendon sheath, while the tendons of the gastrocnemius muscle were mildly hypoechoic, but intact up to the tendon junction. The muscle-tendon junction of the left gastrocnemius muscle revealed the presence of inhomogeneous, moderately vascularized and hypo-anechoic tissue, with a lack of subtotal continuity between the tendon and the muscle, and greater involvement of the lateral portion of the head. A nearly complete discontinuity between the tendon and the muscle was observed, with greater involvement of the lateral head ( Figure 2). The diagnosis was subtotal injury of the muscle–tendon junction of the lateral head of the left gastrocnemius muscle. 2.1.2. Case 2 A 7-year-old spayed female Greyhound, weighing 27 kg, was presented with lameness of the right hindlimb which had occurred after pursuing a wild animal three days earlier. The dog exhibited a mild plantigrade stance, grade 3/4 lameness, suffusion of the skin over the medial aspect of the right thigh, tarsal edema, and no pain or warmth on palpation of the soft tissues. Radiographic examination of the tibia and the tarsus excluded any bone or joint abnormalities, including osteoarthrosis. Ultrasound examination of the right hind limb revealed marked and diffuse thickening of the distal tendon of the gastrocnemius muscle, observed both at the calcaneal insertion (maximum thickness: 13 mm) and at the myotendinous junction (maximum thickness: 15 mm). The proximal portion of the gastrocnemius muscle, cranial to the myotendinous junction, appeared diffusely heterogeneous and hypoechoic, with severe disruption of the normal myofibrillar architecture. Within this context, multiple finely echoic/anechoic areas were identified, consistent with intramuscular fluid collections. In addition, within the altered muscular parenchyma, well-defined, oval hyperechoic foci were detected, somewhat suggestive of intra-muscular mineralization. Anechoic finely particulated fluid was also observed between the muscle bundles, indicative of interstitial fluid accumulation. Those findings were compatible with moderate-to-severe teno-myopathy of the gastrocnemius muscle, most likely of traumatic origin, compatible with possible teno-muscular laceration ( Figure 3). In both cases, the diagnosis was a subtotal injury of the myotendinous junction of the lateral head of the gastrocnemius muscle. A novel surgical technique consisting exclusively of internal immobilization was performed to protect the injured area during the healing process by reducing the mechanical stress and tension on the CCT without direct repair of the myotendinous lesion. Clinical, radiographic and ultrasonographic examinations were carried out at diagnosis. Clinical and ultrasonographic evaluations were carried out postoperatively at 15 days and during a follow-up of 9 months, while radiographs were obtained immediately after surgery and at the final follow-up evaluation. The tarsal descent and standing tarsal flexion angles were measured at 15 days postoperatively rather than immediately after recovery from anesthesia in order to achieve adequate weight bearing. 2.2. Surgical Technique A hock brace with integrated rigid splints (Balto ପ୍ପ, Joyvet srl, Dossobuono, Verona, Italy) was applied and maintained until suture removal. Both patients received antibiotic therapy with cefazolin (22 mg/kg, BID) and anti-inflammatory therapy with robenacoxib (1 mg/kg, SID). The antibiotic therapy was administered for 5 days and the anti-inflammatory therapy was continued for 7 days. The dogs were restricted to controlled short leash walks during the postoperative period. The Bühner tape was removed at 3 and 5 months postoperatively in Cases 2 and 1, respectively, based on serial ultrasonographic assessments confirming satisfactory healing of the myotendinous injury. Tape removal was performed under general anesthesia with the patient positioned in lateral recumbency with the operated limb uppermost, and the medial aspect of the limb aseptically prepared. A first skin incision was made over the knot which was palpable at the level of the tibial crest, and a second incision was performed over the calcaneal tunnel. After blunt dissection of the subcutaneous fascia, the exposed tape was cut and gradually wound around the jaws of a Klemmer forceps, allowing gentle sliding through the subcutaneous tunnel. The skin incisions were routinely sutured. 3. Results 3.1. Case 1 At the preoperative examination, the dog showed grade 2 lameness, the TDA relative to the vertical ground line measured 30° in the affected limb. At 15 days postoperatively, the dog exhibited grade 1 lameness, and the TDA, as expected, had decreased to 16°. The lameness was completely resolved by 3 months, and no further change in the TDA were observed until removal of the tape at 5 months. At 9 months, the last follow-up examination, no lameness was present, the TDA measured 20° compared with 22° in the contralateral limb. The range of motion, when compared with the contralateral joint, was similar in extension and mildly reduced in flexion. Additional data are reported in Table 1. No progression of osteoarthrosis were detected on the 6-month radiographs when compared with the preoperative images ( Figure 5). The first ultrasound follow-up was carried out 40 days after surgery. Moderate improvement was noted with the presence of inhomogeneous hyperechoic tissue (probably scar tissue) close to the muscle-tendon junction. Vascularized hypoechoic areas attributable to the presence of granulation tissue, mainly affecting the lateral head of the gastrocnemius muscle, were also observed. Moderate inhomogeneity was visualized close to tendon insertion on the calcaneal prominence which tended to be hypo-echogenic and moderately vascularized. This aspect was probably due to tissue reaction secondary to the surgical application of prosthetic material. The ultrasound examination carried out four months after surgery showed a marked improvement in the muscle-tendon lesion. Inhomogeneous hyperechoic tissue was observed close to the muscle-tendon junction, probably attributable to fibrous tissue ( Figure 6). There was also a decrease in inhomogeneous anechoic periprosthetic effusion. An ultrasound carried out nine months postoperatively showed the muscle-tendon junction to be fully healed owing to the creation of hyperechoic fibrous tissue which had created a bridge between the muscular belly and the tendon ( Figure 7). The ultrasound image showed the possibility of removing the tape. In general, for both cases, the ultrasound observation of the presence of continuity between the tendon and the muscle belly (regeneration or presence of a fibrous bridge) and the absence of intramuscular effusion were considered highly indicative signs for allowing the removal of the tape. 3.2. Case 2 At the preoperative examination, the dog exhibited grade 3 lameness with a TDA of 42°. At 15 days postoperatively, the dog showed grade 2 lameness and a TDA of 12°. The lameness was resolved in 3 months; no changes in the angles were observed until removal of the tape at 3 months. At the final follow-up examination (9 months), no lameness was present. The TDA was 14° when compared with 8° in the contralateral limb. When compared with the contralateral limb, the range of motion was maintained in extension and showed a mild reduction in flexion. Additional data are reported in Table 1. The radiographic examination at 7 months did not reveal any signs of osteoarthrosis when compared with the preoperative radiographs ( Figure 8). The first ultrasound follow-up carried out almost 30 days after surgery showed progressive improvement of the lesion involving the myotendinous junction of the medial head of the right gastrocnemius muscle, characterized by a reduction in the muscular swelling and resolution of the peritendinous effusion. Mildly increased echogenicity of the soft tissues surrounding the calcaneal tendon was observed, primarily consistent with the chronic evolution of the traumatic process. The medial head of the gastrocnemius muscle continued to be diffusely heterogeneous and hyperechoic. A tension-band was also observed. The last ultrasound follow-up, carried out four months after the removal of the tape, showed improvement in the ultrasonographic appearance of the right tendinous portion, characterized by a muscular thickness comparable to the contralateral side and a mildly heterogeneous echotexture of the myotendinous region, compatible with almost complete healing of the previously described myotendinous lesion. The muscular belly of the right gastrocnemius muscle conserved a mildly heterogeneous echotexture, compatible with chronic sequelae of the traumatic injury ( Figure 9). In both dogs, no pain on palpation or swelling was detected at the drill-hole sites or along the medial aspect of the crus. As expected, tarsal joint flexion was limited due to the tension of the Bühner tape and remained restricted until its removal. At the last follow-up examination, the range of motion of the tarsus was slightly decreased in both dogs only at maximal flexion. 4. Discussion The present report describes a novel surgical technique performed on two dogs having gastrocnemius muscle injury. The aim was to evaluate, by means of a clinical and ultrasonographic follow-up, whether tape applied to reduce the tension on the CCT could facilitate the healing process of the injured muscle. The results obtained appeared to support this hypothesis; however, some considerations should be discussed. In agreement with the literature, ultrasonography was used in the present report as the primary diagnostic modality to monitor the lesions from diagnosis to complete healing and was essential in determining the appropriate timing for implant removal. In fact, a low prevalence of muscle injuries in dogs has been reported in the literature, probably due to the failure in diagnosing the condition [ 12]. Consequently, a correct physical examination followed by a suitable imaging diagnostic approach is mandatory for reaching a good diagnosis. Ultrasonography and magnetic resonance are the most common diagnostic imaging techniques applied in sports medicine [ 13]. However, the veterinary literature shows a more common application of ultrasound for the evaluation of muscle and tendon injuries [ 14, 15, 16]. This diagnostic imaging modality is cost-effective, non-invasive, and frequently obviates the need for sedation. Moreover, ultrasound provides real-time dynamic evaluation, allowing for precise injury localization and severity staging as well as for a serial follow-up of tissue repair [ 13]. This report has several limitations. The technique is not recommended in dogs presenting with a complete plantigrade stance; this usually indicates a complete rupture of the CCT and requires primary tenorrhaphy. In cases of complete rupture, the tape would be required to support the full mechanical load; however, its resistance to extreme tensile forces is unknown, and additional biomechanical studies should be carried out. The limitations of the present report include the small number of cases, the absence of a control group or the absence of a comparison with other fixation techniques using tenorrhaphy, and the lack of objective gait and biomechanical analyses. In addition, the limited number of cases did not allow an assessment of the rare complications potentially associated with the implant system. An additional limitation of the present study is the absence of standardized craniocaudal radiographic follow-up evaluations to objectively assess the potential rotational changes in the limb or the effects on stifle alignment associated with the temporary stabilization technique. This was because the follow-up imaging was primarily focused on the ultrasonographic assessment of musculotendinous healing and implant removal timing. 5. Conclusions The technique described in this report provided temporary stabilization of the tarsocrural joint while reducing tension on the common calcaneus tendon and was associated with healing of the injured muscle in the two dogs. The procedure was minimally invasive, well tolerated, and associated with good medium-term functional recovery without major complications being observed. Larger prospective studies are required before this method can be considered an established alternative to existing immobilization techniques. Author Contributions Conceptualization, S.P. (Stefania Pinna), G.S.; investigation, S.P. (Stefania Pinna), S.P. (Simone Perfetti) and M.D.B.; data curation, S.P. (Simone Perfetti), M.D.B. writing—original draft preparation, S.P. (Stefania Pinna), G.S., S.P. (Simone Perfetti) and M.D.B.; writing—review and editing, S.P. (Stefania Pinna) and G.S.; supervision, S.P. (Stefania Pinna). All authors have read and agreed to the published version of the manuscript. Funding This research received no external funding. Institutional Review Board Statement The study was conducted in accordance with institutional clinical standards, with informed owner consent, and in compliance with applicable Animal Welfare Acts. Informed Consent Statement Informed consent for the diagnostic and surgical procedures, including the novel surgical technique described, participation in the study, and publication of the clinical data and results was obtained from the owners of the 2 dogs involved in this study. Data Availability Statement The data supporting the findings of this study are available within the article. Additional anonymized clinical data are available from the corresponding author upon reasonable request. Acknowledgments The authors wish to thank Barbara Pinna for her generous contribution regarding the drawings included in this manuscript. Conflicts of Interest The authors declare no conflicts of interest. 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Share and Cite MDPI and ACS Style Pinna, S.; Perfetti, S.; Di Benedetto, M.; Spinella, G. A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions. Animals 2026, 16, 1783. https://doi.org/10.3390/ani16121783 AMA Style Pinna S, Perfetti S, Di Benedetto M, Spinella G. A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions. Animals. 2026; 16(12):1783. https://doi.org/10.3390/ani16121783 Chicago/Turabian Style Pinna, Stefania, Simone Perfetti, Matteo Di Benedetto, and Giuseppe Spinella. 2026. "A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions" Animals 16, no. 12: 1783. https://doi.org/10.3390/ani16121783 APA Style Pinna, S., Perfetti, S., Di Benedetto, M., & Spinella, G. (2026). A Novel Minimally Invasive Technique for Internal Tarsal Stabilization in the Management of Canine Gastrocnemius Myotendinous Lesions. Animals, 16(12), 1783. https://doi.org/10.3390/ani16121783 Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here. Article Metrics Article metric data becomes available approximately 24 hours after publication online.

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