Choosing the target wisely: partial tibial nerve transfer to extensor digitorum motor branches with simultaneous posterior tibial tendon transfer. Could this be a way to improve functional outcome and gait biomechanics?

Gatskiy, Alexander A.; Tretyak, Ihor B.; Третьякова, А. И.; Tsymbaliuk, Yaroslav V.

doi:10.3171/2019.3.jns182866

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Tibial nerve branches were transferred to the motor branches of the tibialis anterior in 26 patients in studies by Ferris and Maciburko 32 and Giuffre et al 22 and in 6 patients in a study by Leclère et al 43 . Gatskiy et al performed partial tibial nerve transfer to the extensor digitorum longus and extensor hallucis longus muscles with concurrent PTTT in 7 patients 49 . Two patients in the study by Leclère et al 43 had destruction of the anterior and lateral muscle compartments and accordingly underwent a reconstruction procedure in which the lateral head of the gastrocnemius muscle was transposed onto the tendons of the tibialis anterior muscle group, “with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy.” All 4 studies reported preoperative delay, the mean of which was 5.3 months.…”

Section: Resultsmentioning

confidence: 99%

“…Nerve transfer was performed in 4 studies 22,32,43,49 . Nerve transfer is the process of transferring a functional nerve to a distal denervated nerve by an end-toend epineural suture in a process that usually involves selecting ideal donor and recipient nerve branches based on size, quality, spatial position, and nerve stimulability 22,32 those who underwent nerve grafting (49.0%).…”

Section: Nerve Transfermentioning

confidence: 99%

“…The MRC scale runs from M0 to M5: M0 represents total paralysis, M1 represents a flicker, M2 represents movement with gravity eliminated, M3 represents movement against gravity (no resistance), M4 represents movement against gravity and resistance, and M5 represents normal power 48 . Achieving a grade of $M3 is generally seen as a successful outcome, given that this indicates that the patient is able to dorsiflex the foot against gravity 48 , which may eliminate the need for an ankle-foot orthosis and may improve patients' functional perception 49 .…”

Section: The British Medical Research Council (Mrc) Scalementioning

confidence: 99%

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Traumatic Peroneal Nerve Injuries

Mackay

Ayres²,

Harmon³

et al. 2022

JBJS Reviews

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Background: The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, although improved surgical technique and novel procedures appear to improve outcomes. Given the variety of underlying injury modalities, treatment options, and prognostic variables, we sought to evaluate and summarize the current literature on traumatic CPN injuries and to provide recommendations from an analysis of the included studies for treatment and future research.Methods: A systematic review was performed using PubMed, Embase, and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms consisted of variations of "peroneal nerve" or "fibular nerve" combined with "injury," "laceration," "entrapment," "repair," or "neurolysis." Information with regard to treatment modality, outcomes, and patient demographic characteristics was recorded and analyzed. Results:The initial search yielded 2,301 articles; 42 met eligibility criteria. Factors associated with better outcomes included a shorter preoperative interval, shorter graft length when an interposed graft was used, nerve continuity, and younger patient age. Gender or sex was not mentioned as a factor affecting outcomes in any study. Motor grades of $M3 on the British Medical Research Council (MRC) scale are typically considered successful outcomes. This was achieved in 81.4% of patients who underwent neurolysis, 78.8% of patients who underwent end-to-end suturing, 49.0% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 81.5% of patients who underwent isolated posterior tibial tendon transfer (PTTT), and 84.2% of patients who underwent a surgical procedure with concurrent PTTT.Conclusions: Studies included in this review were heterogenous, complicating our ability to perform further analysis. It is not possible to uniformly advocate for the best treatment option, given diverse injury modalities and patient presentations and a variety of prognostic factors. Many studies do not show outcomes with respect to injury modality. Future studies should show preoperative muscle strengths and should clearly define outcomes based on the injury modality and surgical treatment option. This would allow for greater analysis of the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques are promising and should be further explored.

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Section: Resultsmentioning

confidence: 99%

Section: Nerve Transfermentioning

confidence: 99%

Section: The British Medical Research Council (Mrc) Scalementioning

confidence: 99%

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Traumatic Peroneal Nerve Injuries

Mackay

Ayres²,

Harmon³

et al. 2022

JBJS Reviews

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Assessment, management, and rehabilitation of traumatic peripheral nerve injuries for non‐surgeons

Bateman,

Pripotnev,

Larocerie‐Salgado

et al. 2024

Muscle and Nerve

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Electrodiagnostic evaluation is often requested for persons with peripheral nerve injuries and plays an important role in their diagnosis, prognosis, and management. Peripheral nerve injuries are common and can have devastating effects on patients' physical, psychological, and socioeconomic well‐being; alongside surgeons, electrodiagnostic medicine specialists serve a central function in ensuring patients receive optimal treatment for these injuries. Surgical intervention—nerve grafting, nerve transfers, and tendon transfers—often plays a critical role in the management of these injuries and the restoration of patients' function. Increasingly, nerve transfers are becoming the standard of care for some types of peripheral nerve injury due to two significant advantages: first, they shorten the time to reinnervation of denervated muscles; and second, they confer greater specificity in directing motor and sensory axons toward their respective targets. As the indications for, and use of, nerve transfers expand, so too does the role of the electrodiagnostic medicine specialist in establishing or confirming the diagnosis, determining the injury's prognosis, recommending treatment, aiding in surgical planning, and supporting rehabilitation. Having a working knowledge of nerve and/or tendon transfer options allows the electrodiagnostic medicine specialist to not only arrive at the diagnosis and prognosticate, but also to clarify which nerves and/or muscles might be suitable donors, such as confirming whether the branch to supinator could be a nerve transfer donor to restore distal posterior interosseous nerve function. Moreover, post‐operative testing can determine if nerve transfer reinnervation is occurring and progress patients' rehabilitation and/or direct surgeons to consider tendon transfers.

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