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

Ferris, Scott; Maciburko, Simon J.

doi:10.1002/micr.30174

Cited by 23 publications

(32 citation statements)

References 21 publications

(41 reference statements)

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“…Given that only 20% of a muscle's axons are needed to produce normal function, partial nerve transfer can reinnervate a target while maintaining donor motor function. Although restoration of dorsiflexion via nerve transfer (Ferris & Maciburko, 2017;Flores, Martins, & Siqueira, 2013;Giuffre, Bishop, Spinner, Levy, & Shin, 2012;Leclère, Badur, Mathys, & Vögelin, 2015;Nath, Lyons, & Paizi, 2008) has been documented in adults, outcomes are limited, success is variable, and recent systematic review of these procedures demonstrated a bimodal distribution with regards to recovery of dorsiflexion-with a majority either demonstrating MRC 0 or 4 strength postoperatively (Head et al, 2019). The application of nerve transfer to lower extremity reconstruction is uncommon and its utility is evolving.…”

Section: Discussionmentioning

confidence: 99%

“…We avoided branches to soleus (Ferris & Maciburko, 2017;Flores et al, 2013;Pirela-Cruz, Hansen, Terreros, Rossum, & West, 2009), gastrocnemius (Flores et al, 2013;Giuffre et al, 2012), and tibialis posterior as their sacrifice could weaken "push-off," interfere with the option of subsequent tendon transfer, provide limited donor nerve length, and activate out of phase and antagonistic to TA function.…”

Section: Discussionmentioning

confidence: 99%

“…In doing so, impedance by persistent nerve compression would be reduced and axons would be directed to the muscle with greatest functional benefit. In all three cases, we used a different approach than previous reports that describe a limited donor nerve fascicular dissection and the need to route nerves through the interosseous membrane (Ferris & Maciburko, 2017;Giuffre et al, 2012;Leclère et al, 2015;Pirela-Cruz et al, 2009). In contrast, we lysed donor fascicles to their distal terminal branches as they entered muscle, thereby obtaining abundant donor nerve length for direct coaptation through a simple exposure.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…Some centers perform nerve transfer of tibial nerve branches to branches to the tibialis anterior in cases of peroneal nerve injury. 2,11 Understanding the topographical organization of the tibial nerve is also important in these cases. These nerve transfers are typically performed at the level of branches of the tibial nerve, typically using branches to the flexor digitorum longus, flexor hallucis longus, or soleus.…”

Section: Discussionmentioning

confidence: 99%

The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

Wilson

Maldonado²,

Amrami

et al. 2019

Journal of Neurosurgery

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The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland’s fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

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“…In combining the four studies we were able to identify in the literature, 35 total patients underwent tibial nerve transfer for CPN palsy, of which 21 obtained an MRC grade of 3 or higher for dorsiflexion. [59][60][61][62] Posterior Tibialis Tendon Transfer PTTT is a reliable salvage treatment option in the setting of failed nerve-saving procedures or delayed treatment. The posterior tibialis tendon is transferred to the dorsum of the foot either by attachment on the medial cuneiform or the tibialis anterior tendon itself.…”

Section: Nerve Grafting and Nerve Transfermentioning

confidence: 99%

Neurologic Assessment and Management of the Multiple Ligament Injured Knee: A Review and Synthesis of Current Evidence

2019

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Knee dislocations are rare but devastating injuries that can often be associated with concomitant nerve injury, most often of the common peroneal nerve. Prompt diagnosis, investigation, and appropriate treatment are important in this subset of patients. This article provides an overview of relevant injury demographics, anatomy, diagnosis, and prognosis, and suggests a treatment algorithm for nerve injury associated with multiligament knee injury.

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

Abstract: This series provides good evidence that this evolving reconstructive technique may achieve excellent results and should be considered in traumatic common peroneal nerve injuries that would traditionally rely on conventional nerve grafting alone.

Cited by 23 publications

References 21 publications

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

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

The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

Neurologic Assessment and Management of the Multiple Ligament Injured Knee: A Review and Synthesis of Current Evidence

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