An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

George, Samuel; Boyce, Dean E.

doi:10.1097/prs.0000000000000318

Cited by 55 publications

(57 citation statements)

References 44 publications

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“…This finding was not confirmed via electromyography as the authors felt the additional testing of a clinically apparent finding wound not change subsequent patient management or benefit patient outcome. This finding is not completely unexpected given the average length of cable grafts being 19 cm and the success rate for grafts of this length being <11% in the published literature (George & Boyce, ). As with other series, our cohort size was too small to draw any significant conclusion regarding the prognostic factors of age, palsy duration, and mechanism of injury and no significant donor nerve deficits have been noticed in our cohort.…”

Section: Discussionmentioning

confidence: 66%

“…This technique allows the zone of injury to be bypassed without the need for nerve grafts and minimizes the regeneration time by reconstructing the nerve as close to the motor endplates as possible (Brown, Shah, & Mackinnon, ). George and Boyce () published an extensive structured literature review of 28 studies incorporating 431 CPN injuries that were repaired with interfascicular nerve grafting. Good outcomes (≥M4) were only reported in 36% of repairs and were very much dependent on graft length.…”

Section: Discussionmentioning

confidence: 99%

“…When a graft was <6 cm in length, 64% achieved good results; however, this was only possible in 33% of patients. The majority of CPN injuries (67%) required grafts >6 cm in length, and those grafts between 6 and 12 cm only achieved good results in 29%, while those grafts >12 cm only achieved good results in 11% of repairs (George & Boyce, ).…”

Section: Discussionmentioning

confidence: 99%

“…Tibialis posterior tendon transfer can achieve active ankle dorsiflexion to an extent but can require significant retraining, has variable ultimate function, and comes with the risk of donor site morbidity (Richard, ). Nerve grafting is well known to have less than ideal outcomes, especially when >6 cm in length, and therefore has limited usefulness for the typically lengthy CPN injuries (George & Boyce, ; Kim, Murovic, Tiel, & Kline, ; Sedel & Nizard, ; Wood, ).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

Ferris

Maciburko

2017

Microsurgery

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

Ferris

Maciburko

2017

Microsurgery

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“…Injured CPN caused by a variety of factors led to foot drop and loss of function of thumb and toe extension, as well as sensory disturbance of innervated region, which affect tremendously on patient's daily life. Although the regeneration ability of the peripheral nerve is stronger than that of the central nerve system and the function of peripheral nerve can be recovered to a certain extent, the injured peripheral nerve cannot recover under some circumstances [6,7]. However, there are significant differences in prognosis of different peripheral nerve injuries.…”

mentioning

confidence: 99%

Analysis of Prognostic Risk Factors for Operative Common Peroneal Nerve: A Nest Case-Control Study

Liu¹,

Yushan²,

Liu³

et al. 2020

Preprint

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Background Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the factors associated with the neural recovery of injured CPN in patients undergoing surgical exploration of CPN.Methods This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to assess which explanatory variables are associated with recovery of neurological function. We used multivariable logistic regression analysis to determine variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results There were 67 patients divided into case group and 320 patients divided into control group. In multivariate logistic regression analysis, we found that city area (OR = 3.35), labor occupation (OR = 4.39), diabetes (OR = 11.68), cardiovascular disease (OR = 51.35), knee joint dislocation (OR = 14.91), proximal fibula fracture (OR = 3.32), tibial plateau fracture (OR = 9.21), vascular injury (OR = 5.37) and hip arthroplasty (OR = 75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR = 0.18) and postoperative knee joint immobilization (OR = 0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863–0.946.Conclusions City area, labor occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factor of motor functional recovery of injured CPN. The prediction nomogram can be used to predict the prognosis of injured CPN.

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Partial tibial nerve transfer for foot drop from deep peroneal palsy: Lessons from three pediatric cases

et al. 2020

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Peroneal nerve palsy with resultant foot drop has significant impacts on gait and quality of life. Traditional management includes ankle-foot-orthosis, tendon transfer, and arthrodesis-each with certain disadvantages. While nerve transfers for peroneal nerve injury have been reported in adults, with variable results, they have not been described in the pediatric population. We report the use of partial tibial nerve transfer for foot drop from deep peroneal nerve palsy in three pediatric patients. The first sustained a partial common peroneal nerve laceration and underwent transfer of a single tibial nerve branch to deep peroneal nerve 7 months after injury. Robust extensor hallucis longus and extensor digitorum longus reinnervation was obtained without satisfactory tibialis anterior function. The next patient sustained a thigh laceration with partial sciatic nerve injury and underwent transfer of two tibial nerve branches directly to the tibialis anterior component of deep peroneal nerve 9 months after injury. The final patient sustained a blast injury to the posterior knee and similarly underwent a double fascicular transfer directly to tibialis anterior 4 months after injury. The latter two patients obtained sufficient strength (MRC 4-5) at 1 year to discontinue orthosis. In all patients, we used flexor hallucis longus and/or flexor digitorum longus branches as donors without postoperative loss of toe flexion. Overall, our experience suggests that early double fascicular transfer to an isolated tibialis anterior target, combined with decompression, could produce robust innervation.Further study and collaboration are needed to devise new ways to treat lower extremity nerve palsies.

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An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

Abstract: Common peroneal nerve repair was worthwhile in approximately half of all cases. The authors suggest that the results of common peroneal nerve repair will be suboptimal if surgery is performed more than 12 months after injury or if a graft of more than 12 cm is required.

Cited by 55 publications

References 44 publications

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

Analysis of Prognostic Risk Factors for Operative Common Peroneal Nerve: A Nest Case-Control Study

Partial tibial nerve transfer for foot drop from deep peroneal palsy: Lessons from three pediatric cases

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