Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens

Trappeniers, Laurence; Maeseneer, Michel De; Roy, Peter Van; Chaskis, Cristo; Osteaux, M

doi:10.1007/s00330-003-1833-8

Cited by 25 publications

(18 citation statements)

References 10 publications

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“…4,5,10,15 The mechanism has been thought to be a stretch lesion to the posterolateral aspect of the knee. 24 Because of the broad zone of injury seen clinically, patients often fare poorly and do not recover either spontaneously or even when treated with long interpositional grafts. Salvage procedures such as posterior tibialis tendon transfer may be necessary to eliminate the need for an ankle-foot orthosis.…”

mentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1–4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.

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mentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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“…Different methods have been described for imaging-anatomic correlation [1,3]. A few studies made correlations between anatomic specimens and ultrasound findings [4,5]. We describe a new method for ultrasound-anatomic correlation.…”

Section: Discussionmentioning

confidence: 98%

“…In CT and MR imaging, correlations with anatomic dissection or anatomic slices have been widely performed, especially in certain subspecialty areas such as musculoskeletal imaging [1,2,3,4,5]. The use of such correlation methods is less well developed in the field of ultrasound.…”

Section: Introductionmentioning

confidence: 98%

Ultrasound during dissection of cadaveric specimens: a new method for obtaining ultrasound?anatomic correlations in musculoskeletal radiology

et al. 2004

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We report a new technique for ultrasound-anatomic correlations consisting of dissection of embalmed specimens during ultrasound examination. Our method consists of performing ultrasound during the different stages of dissection. The technique was developed by making observations of selected structures in two embalmed and two non-embalmed cadaver hands. The image quality was subjectively graded by consensus of two investigators, before and after denudation of the selected structures of the hand. As an example, the technique is demonstrated for the flexors at the metacarpophalangeal joint level, the extensor complex at the level of the proximal phalanx, and the dorsal hood of the second to fourth fingers. Before dissection the image quality in fresh specimens was graded moderate, and in embalmed specimens good. After dissection the image quality was good in fresh specimens and excellent in embalmed specimens. Our method is simple and does not require sophisticated material. Our results indicate that embalmed specimens could be better than non-embalmed specimens, because of the presence of artefacts in the non-embalmed specimens (gas deposits). The described methodology can yield excellent results regarding precise identification of different interfaces and structures, as observed at ultrasound.

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“…In the presence of a nerve pathology, MRI can provide information about the distance between the nerve ends when there is complete disruption, presence of constrictive perineural scar tissue, posttraumatic neuroma in chronic injuries surrounding edema, encasing hematoma in the epineurium, mild contusion, and partial disruption of the fibers. 25,44 Peltola et al 26 found a high correlation between patients who had no clinical signs or symptoms of peroneal nerve injury and normal peroneal nerve findings on MRI.…”

Section: Mrimentioning

confidence: 99%

“…26,44 The CPN is typically adjacent to the posterior margin of the biceps tendon and deep to the crural fascia in the posterolateral aspect of the knee. In the presence of a nerve pathology, MRI can provide information about the distance between the nerve ends when there is complete disruption, presence of constrictive perineural scar tissue, posttraumatic neuroma in chronic injuries surrounding edema, encasing hematoma in the epineurium, mild contusion, and partial disruption of the fibers.…”

Section: Mrimentioning

confidence: 99%

Drop Foot After Knee Dislocation

Cush

Irgıt

2011

Sports Medicine and Arthroscopy Review

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Although knee dislocations are relatively rare, serious complications make treatment difficult. Common peroneal nerve (CPN) palsy is a debilitating complication and its incidence has been reported as high as 50%. Even after successful ligament construction, unresolved CPN palsy is a major factor contributing to poor outcomes after knee dislocations. CPN palsy is more common with open dislocations, rotatory dislocations, and especially occurs in patients with posterolateral corner injuries. CPN palsy can be readily diagnosed clinically, although a high index of suspicion is needed. The risk versus benefits of surgical exploration in the acute setting is still under debate. Conservative management can be appropriate in the early phase of treatment, however, for persistent nerve damage, surgery is the treatment of choice because it results in better functional outcomes. Neurolysis, primary nerve repair, nerve grafting, and posterior tibialis tendon transfer have all been used by surgeons as viable surgical treatment options. As late surgical treatment of CPN typically results in poor prognosis, awareness of this injury, thorough physical examination and documentation of the nerve injury, and close follow-up are of paramount importance.

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Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens

Cited by 25 publications

References 10 publications

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Ultrasound during dissection of cadaveric specimens: a new method for obtaining ultrasound?anatomic correlations in musculoskeletal radiology

Drop Foot After Knee Dislocation

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