The Open Orthopaedics Journal


ISSN: 1874-3250 ― Volume 11, 2017
RESEARCH ARTICLE

Cadaveric Study of the Junction Point Where the Gastrocnemius Aponeurosis Joins the Soleus Aponeurosis



Tun Hing Lui*, Chong Yin Mak
Department of Orthopaedics and Traumatology, North District Hospital 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China

Abstract

Purpose:

To study the location of the junction point where the gastrocnemius aponeurosis joins the soleus aponeurosis to form the Achilles tendon.

Methods:

Twelve lower limb specimens were used. The distance between the medial tibial plateau and the superior border of the posterior calcaneal tubercle (A) was measured and the distances of the junction point to the superior border of the posterior calcaneal tubercle (B) were measured.

Result:

The ratio B/A averaged 0.45. The gastrocnemius muscle reached or extended beyond the junction point in eight specimens (67%). The average distance from the lowest border of the muscle to the junction point was 0±12mm (-25-25).

Conclusion:

There are great anatomical variations of the gastrocnemius insertion. Resection of muscle bound portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.

Clinical Relevance:

This report suggests that resection of muscle bound portion rather than the muscle void portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.

Keywords: Gastrocnemius, Aponeurosis, Recession, Endoscopy.


Article Information


Identifiers and Pagination:

Year: 2017
Volume: 11
Issue: Suppl-4, M16
First Page: 762
Last Page: 767
Publisher Id: TOORTHJ-11-762
DOI: 10.2174/1874325001711010762

Article History:

Received Date: 07/2/2016
Revision Received Date: 19/7/2016
Acceptance Date: 23/07/2016
Electronic publication date: 31/07/2017
Collection year: 2017

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© 2017 Lui and Mak.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong; Tel: (852) 26837588; Emails: luithderek@yahoo.co.uk; luith@ha.org.hk




INTRODUCTION

A gastrocnemius equinus is typically characterized by less than 10° of ankle dorsiflexion with the knee extended with positive Silfverskiold test [1Herzenberg JE, Lamm BM, Corwin C, Sekel J. Isolated recession of the gastrocnemius muscle: The Baumann procedure. Foot Ankle Int 2007; 28(11): 1154-9.
[http://dx.doi.org/10.3113/FAI.2007.1154] [PMID: 18021583]
]. This can lead to various secondary problems, including Achilles tendinosis, flatfoot, lower back pain or strain, knee hyperextension (genu recurvatum), plantar fasciitis, midfoot pain or arthritis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers [2Barske HL, DiGiovanni BF, Douglass M, Nawoczenski DA. Current concepts review: Isolated gastrocnemius contracture and gastrocnemius recession. Foot Ankle Int 2012; 33(10): 915-21.
[http://dx.doi.org/10.3113/FAI.2012.0915] [PMID: 23050719]
-5Pinney SJ, Hansen ST Jr, Sangeorzan BJ. The effect on ankle dorsiflexion of gastrocnemius recession. Foot Ankle Int 2002; 23(1): 26-9.
[http://dx.doi.org/10.1177/107110070202300105] [PMID: 11822689]
]. Gastrocnemius recession surgery is performed to weaken or eliminate the gastrocnemius muscle’s plantarflexory action on the foot [6Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its muscular bound portion: A cadaveric study-part II. J Foot Ankle Surg 2008; 47(6): 533-40.
[http://dx.doi.org/10.1053/j.jfas.2008.08.006] [PMID: 19239863]
, 7Chimera NJ, Castro M, Davis I, Manal K. The effect of isolated gastrocnemius contracture and gastrocnemius recession on lower extremity kinematics and kinetics during stance. Clin Biomech (Bristol, Avon) 2012; 27(9): 917-23.
[http://dx.doi.org/10.1016/j.clinbiomech.2012.06.010] [PMID: 22819670]
]. Open gastrocnemius recession can be at either the gastrocnemius aponeurosis distal to the gastrocnemius muscle attachment [8Chimera NJ, Castro M, Manal K. Function and strength following gastrocnemius recession for isolated gastrocnemius contracture. Foot Ankle Int 2010; 31(5): 377-84.
[http://dx.doi.org/10.3113/FAI.2010.0377] [PMID: 20460063]
-11Strayer LM Jr. Gastrocnemius recession; five-year report of cases. J Bone Joint Surg Am 1958; 40-A(5): 1019-30.
[http://dx.doi.org/10.2106/00004623-195840050-00004] [PMID: 13587570]
] or at the anterior surface of the muscle bound portion of the gastrocnemius aponeurosis [1Herzenberg JE, Lamm BM, Corwin C, Sekel J. Isolated recession of the gastrocnemius muscle: The Baumann procedure. Foot Ankle Int 2007; 28(11): 1154-9.
[http://dx.doi.org/10.3113/FAI.2007.1154] [PMID: 18021583]
, 6Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its muscular bound portion: A cadaveric study-part II. J Foot Ankle Surg 2008; 47(6): 533-40.
[http://dx.doi.org/10.1053/j.jfas.2008.08.006] [PMID: 19239863]
, 12Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its insertion: A cadaveric study. J Foot Ankle Surg 2007; 46(2): 101-8.
[http://dx.doi.org/10.1053/j.jfas.2006.11.003] [PMID: 17331869]
-15Baumann JU, Koch HG. Lengthening of the anterior aponeurosis of the gastrocnemius muscle. Oper Orthop Traumatol 1989; 1: 254.
[http://dx.doi.org/10.1007/BF02514828]
]. Endoscopic gastrocnemius recessions have been developed recently and reported to have fewer complications and better cosmetic outcome [2Barske HL, DiGiovanni BF, Douglass M, Nawoczenski DA. Current concepts review: Isolated gastrocnemius contracture and gastrocnemius recession. Foot Ankle Int 2012; 33(10): 915-21.
[http://dx.doi.org/10.3113/FAI.2012.0915] [PMID: 23050719]
, 3Grady JF, Kelly C. Endoscopic gastrocnemius recession for treating equinus in pediatric patients. Clin Orthop Relat Res 2010; 468(4): 1033-8.
[http://dx.doi.org/10.1007/s11999-009-1084-3] [PMID: 19763722]
, 16Adelman VR, Szczepanski JA, Adelman RP. Radiographic evaluation of endoscopic gastrocnemius recession, subtalar joint arthroereisis, and flexor tendon transfer for surgical correction of stage II posterior tibial tendon dysfunction: A pilot study. J Foot Ankle Surg 2008; 47(5): 400-8.
[http://dx.doi.org/10.1053/j.jfas.2008.06.005] [PMID: 18725119]
-26Yeap EJ, Shamsul SA, Chong KW, Sands AK. Simple two-portal technique for endoscopic gastrocnemius recession: Clinical tip. Foot Ankle Int 2011; 32(8): 830-3.
[http://dx.doi.org/10.3113/FAI.2011.0830] [PMID: 22049872]
]. They have been used as an adjunctive treatment of posterior tibial tendon dysfunction, forefoot nerve entrapment, metatarsalgia, refractory Achilles tendinopathy, cerebral palsy and pediatric pes planovalgus [16Adelman VR, Szczepanski JA, Adelman RP. Radiographic evaluation of endoscopic gastrocnemius recession, subtalar joint arthroereisis, and flexor tendon transfer for surgical correction of stage II posterior tibial tendon dysfunction: A pilot study. J Foot Ankle Surg 2008; 47(5): 400-8.
[http://dx.doi.org/10.1053/j.jfas.2008.06.005] [PMID: 18725119]
, 18Barrett SL, Jarvis J. Equinus deformity as a factor in forefoot nerve entrapment: Treatment with endoscopic gastrocnemius recession. J Am Podiatr Med Assoc 2005; 95(5): 464-8.
[http://dx.doi.org/10.7547/0950464] [PMID: 16166465]
-20Poul J, Tůma J, Bajerová J. Video-assisted gastrocnemius-soleus and hamstring lengthening in cerebral palsy patients. J Pediatr Orthop B 2008; 17(2): 81-4.
[http://dx.doi.org/10.1097/01.bpb.0000302748.66435.e9] [PMID: 18510164]
, 27Cicchinelli LD, Pascual Huerta J, García Carmona FJ, Fernández Morato D. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: A radiographic retrospective study. J Foot Ankle Surg 2008; 47(5): 385-91.
[http://dx.doi.org/10.1053/j.jfas.2008.06.002] [PMID: 18725117]
-29Greenhagen RM, Johnson AR, Peterson MC, Rogers LC, Bevilacqua NJ. Gastrocnemius recession as an alternative to tendoAchillis lengthening for relief of forefoot pressure in a patient with peripheral neuropathy: A case report and description of a technical modification. J Foot Ankle Surg 2010; 49(2): 159.e9-159.e13.
[http://dx.doi.org/10.1053/j.jfas.2009.07.002] [PMID: 20137982]
]. The endoscopic techniques are mostly an endoscopic approach of the Strayer-type of complete recession of the gastrocnemius aponeurosis. As a minimally invasive approach, the portal wounds are small and therefore it should be accurately placed at the level of the muscle void portion of the gastrocnemius aponeurosis. We believe that the junction point where the gastrocnemius aponeurosis joins the soleus aponeurosis to form the Achilles tendon is an important landmark. The endoscopic gastrocnemius aponeurosis recession can be performed just proximal to this point. In this study, the relationships between the junction point and the surrounding surface anatomic landmark was studied. We hypothesized that the junction point can be accurately determined by studying the relationship of the point with the other surface landmarks.

METHODS

Twelve lower limb specimens from 6 fresh frozen Chinese cadavers (5 male and 1 female) were used. The average age of succumb was 79.5 year old (65-91). None of the cadavers had deformity, trauma or any surgery of their lower limb. The skin was resected to expose the muscles, bones and joints. The junction point where the gastrocnemius aponeurosis joined the soleus aponeurosis was identified (Fig. 1). The distance between the medial tibial plateau and the superior border of the posterior calcaneal tubercle was measured with the ankle and subtalar joints in neutral position. The junction point of the gastrocnemius and soleus aponeuroses was identified and the distance of this point to the superior border of the posterior calcaneal tubercle was measured. The distance from the lowest border of the gastrocnemius muscle to the junction point was also measured.

Fig. (1)
Specimen showing that the junction point (a) where the gastrocnemius aponeurosis (b) joined the soleus apoeneurosis (c). d: gastrocnemius muscle.


RESULTS

The results of the cadaveric study were summarized in (Table 1).

Table 1
Summary of the distance from the junction point to the posterior calcaneal tubercle and the distance between the junction point and the lowest point of the gastrocnemius muscle.


The average distance between the medial tibial plateau and the superior border of the posterior calcaneal tubercle (A) was 373±27mm (335-415). The average distance between the junction point and the superior border of the posterior calcaneal tubercle (B) was 168±20mm (120-190). The ratio B/A averaged 0.45±0.07 (0.31-0.54). The gastrocnemius muscle reached or extended beyond the junction point in eight specimens (67%). The average distance from the lowest border of the muscle to the junction point was 0±12mm (-25-25).

DISCUSSION

In this study, the junction point cannot be accurately determined by surface landmarks. Moreover, muscle-void portion of the gastrocnemius aponeurosis that allowing Strayer-type of endoscopic gastrocnemius aponeurosis recession was identified in only four (33%) specimens. In these 4 specimens, the muscle void portion of gastrocnemius sponeurosis was at most 25mm in length, which was a narrow zone that may be difficult to locate accurately during endoscopic gastrocnemius aponeurosis recession.

Endoscopic gastrocnemius aponeurosis recessions allow release of the gastrocnemius aponeurosis under arthroscopic visualization through small portal wounds. The reported techniques target the exposed inferior portion of the aponeurosis that is not directly covered by muscle [2Barske HL, DiGiovanni BF, Douglass M, Nawoczenski DA. Current concepts review: Isolated gastrocnemius contracture and gastrocnemius recession. Foot Ankle Int 2012; 33(10): 915-21.
[http://dx.doi.org/10.3113/FAI.2012.0915] [PMID: 23050719]
, 3Grady JF, Kelly C. Endoscopic gastrocnemius recession for treating equinus in pediatric patients. Clin Orthop Relat Res 2010; 468(4): 1033-8.
[http://dx.doi.org/10.1007/s11999-009-1084-3] [PMID: 19763722]
, 16Adelman VR, Szczepanski JA, Adelman RP. Radiographic evaluation of endoscopic gastrocnemius recession, subtalar joint arthroereisis, and flexor tendon transfer for surgical correction of stage II posterior tibial tendon dysfunction: A pilot study. J Foot Ankle Surg 2008; 47(5): 400-8.
[http://dx.doi.org/10.1053/j.jfas.2008.06.005] [PMID: 18725119]
-26Yeap EJ, Shamsul SA, Chong KW, Sands AK. Simple two-portal technique for endoscopic gastrocnemius recession: Clinical tip. Foot Ankle Int 2011; 32(8): 830-3.
[http://dx.doi.org/10.3113/FAI.2011.0830] [PMID: 22049872]
]. Different surface landmarks including the distal border of the gastrocnemius muscle [22Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 2004; 43(5): 302-6.
[http://dx.doi.org/10.1053/j.jfas.2004.07.001] [PMID: 15480405]
, 23Schroeder SM. Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade. J Foot Ankle Surg 2012; 51(6): 714-9.
[http://dx.doi.org/10.1053/j.jfas.2012.08.002] [PMID: 22981393]
], the fibula length [30Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW. Anatomic study of the gastrocnemius-soleus junction and its relationship to the sural nerve. Foot Ankle Int 2003; 24(6): 473-6.
[http://dx.doi.org/10.1177/107110070302400604] [PMID: 12854667]
] and the medial malleolus [22Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 2004; 43(5): 302-6.
[http://dx.doi.org/10.1053/j.jfas.2004.07.001] [PMID: 15480405]
] have been used to locate the muscle void portion of the gastrocnemius aponeurosis. However, these localization methods are of doubtful accuracy because of the anatomical variations of the gastrocnemius insertion. The location where the gastrocnemius aponeurosis joins the soleus aponeurosis and the length of the muscle void portion of the gastrocnemius aponeurosis can be variable and the gastrocnemius muscle can even insert directly onto the tendinous superficial surface of the soleus [12Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its insertion: A cadaveric study. J Foot Ankle Surg 2007; 46(2): 101-8.
[http://dx.doi.org/10.1053/j.jfas.2006.11.003] [PMID: 17331869]
]. If the portal wounds are not placed at the level of the muscle void portion of gastrocnemius aponeurosis, the wounds needed to be extended and the goal of “minimally incision surgery” is defeated. On the other hand, endoscopic resection of the gastrocnemius aponeurosis that is covered by the gastrocnemius muscle has a more constant surface landmark [31Lui TH. Modified endoscopic release of gastrocnemius aponeurosis. J Foot Ankle Surg 2015; 54(1): 140-2.
[http://dx.doi.org/10.1053/j.jfas.2014.07.014] [PMID: 25223945]
, 32Lui TH. Endoscopic gastrocnemius intramuscular aponeurotic recession. Arthrosc Tech 2015; 4(5): e615-8.
[http://dx.doi.org/10.1016/j.eats.2015.06.011] [PMID: 26900563]
]. From this study, the muscle-bound portion of the gastrocnemius aponeurosis can be confidently reached if the portal wounds are more than 25mm above the inferior border of the gastrocnemius muscle and will not be affected by the gastrocnemius variable insertion. This approach preserves the insertion of gastrocnemius, allowing for both an intramuscular and aponeurotic lengthening [6Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its muscular bound portion: A cadaveric study-part II. J Foot Ankle Surg 2008; 47(6): 533-40.
[http://dx.doi.org/10.1053/j.jfas.2008.08.006] [PMID: 19239863]
, 13Blitz NM, Rush SM. The gastrocnemius intramuscular aponeurotic recession: A simplified method of gastrocnemius recession. J Foot Ankle Surg 2007; 46(2): 133-8.
[http://dx.doi.org/10.1053/j.jfas.2007.01.004] [PMID: 17331875]
]. It can lessen the force applied by the gastrocnemius muscle on the foot without entirely decommissioning the muscle’s biomechanical influence [6Blitz NM, Eliot DJ. Anatomical aspects of the gastrocnemius aponeurosis and its muscular bound portion: A cadaveric study-part II. J Foot Ankle Surg 2008; 47(6): 533-40.
[http://dx.doi.org/10.1053/j.jfas.2008.08.006] [PMID: 19239863]
]. In contrast to the Strayer-type of endoscopic gastrocnemius aponeurosis recession, preservation of the gastrocnemius insertion allows the gastrocnemius to maintain a “weakened” effect on the foot and the amount of calf atrophy would be diminished [13Blitz NM, Rush SM. The gastrocnemius intramuscular aponeurotic recession: A simplified method of gastrocnemius recession. J Foot Ankle Surg 2007; 46(2): 133-8.
[http://dx.doi.org/10.1053/j.jfas.2007.01.004] [PMID: 17331875]
]. Moreover, the sural nerve will be protected by the gastrocnemius muscle during endoscopic recession of the muscle-bound portion of the gastrocnemius aponeurosis and the risk of iatrogenic sural nerve injury will be lessened [13Blitz NM, Rush SM. The gastrocnemius intramuscular aponeurotic recession: A simplified method of gastrocnemius recession. J Foot Ankle Surg 2007; 46(2): 133-8.
[http://dx.doi.org/10.1053/j.jfas.2007.01.004] [PMID: 17331875]
, 24Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW. Endoscopic gastrocnemius recession: Evaluation in a cadaver model. Foot Ankle Int 2003; 24(8): 607-13.
[http://dx.doi.org/10.1177/107110070302400807] [PMID: 12956566]
].

Clinical relevance of this report is that it suggests that resection of muscle bound portion rather than the muscle void portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.

CONCLUSION

There are great anatomical variations of the gastrocnemius insertion. Resection of muscle bound portion of the gastrocnemius aponeurosis is a more appropriate approach of endoscopic gastrocnemius aponeurosis recession.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No Animals/Humans were used for studies that are base of this research.

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFRENCES

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[2] Barske HL, DiGiovanni BF, Douglass M, Nawoczenski DA. Current concepts review: Isolated gastrocnemius contracture and gastrocnemius recession. Foot Ankle Int 2012; 33(10): 915-21.
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[19] DiDomenico LA, Adams HB, Garchar D. Endoscopic gastrocnemius recession for the treatment of gastrocnemius equinus. J Am Podiatr Med Assoc 2005; 95(4): 410-3.
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[20] Poul J, Tůma J, Bajerová J. Video-assisted gastrocnemius-soleus and hamstring lengthening in cerebral palsy patients. J Pediatr Orthop B 2008; 17(2): 81-4.
[http://dx.doi.org/10.1097/01.bpb.0000302748.66435.e9] [PMID: 18510164]
[21] Roukis TS, Schweinberger MH. Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: An observational case series. J Foot Ankle Surg 2010; 49(1): 68-70.
[http://dx.doi.org/10.1053/j.jfas.2009.07.018] [PMID: 20123291]
[22] Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg 2004; 43(5): 302-6.
[http://dx.doi.org/10.1053/j.jfas.2004.07.001] [PMID: 15480405]
[23] Schroeder SM. Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade. J Foot Ankle Surg 2012; 51(6): 714-9.
[http://dx.doi.org/10.1053/j.jfas.2012.08.002] [PMID: 22981393]
[24] Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW. Endoscopic gastrocnemius recession: Evaluation in a cadaver model. Foot Ankle Int 2003; 24(8): 607-13.
[http://dx.doi.org/10.1177/107110070302400807] [PMID: 12956566]
[25] Trevino S, Gibbs M, Panchbhavi V. Evaluation of results of endoscopic gastrocnemius recession. Foot Ankle Int 2005; 26(5): 359-64.
[http://dx.doi.org/10.1177/107110070502600503] [PMID: 15913518]
[26] Yeap EJ, Shamsul SA, Chong KW, Sands AK. Simple two-portal technique for endoscopic gastrocnemius recession: Clinical tip. Foot Ankle Int 2011; 32(8): 830-3.
[http://dx.doi.org/10.3113/FAI.2011.0830] [PMID: 22049872]
[27] Cicchinelli LD, Pascual Huerta J, García Carmona FJ, Fernández Morato D. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: A radiographic retrospective study. J Foot Ankle Surg 2008; 47(5): 385-91.
[http://dx.doi.org/10.1053/j.jfas.2008.06.002] [PMID: 18725117]
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Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


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