Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: An anatomical study

Abstract

Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury.

Human distal sciatic nerve fascicular anatomy: Implications for ankle control using nerve-cuff electrodes

“…Our measurements of nerve diameter and crosssectional areas are consistent with those reported by Bodily et al [27]. However, dimensions of cross-sections in the nerve (sex unknown) examined by McKinley were consistently smaller than those found in our study [17].…”

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

“…The peroneal nerve, often ruptured in knee dislocations, can sustain an injury from its proximal origin high in the popliteal fossa to several centimeters distal to the fibular head, a distance spanning greater than 15 cm [1,16]. The common peroneal nerve injury results in loss of sensation to the dorsum of the foot and gait-altering paralysis of the tibialis anterior and the peroneus muscles.…”

“…Users of AFOs are generally unsatisfied and noncompliant with the device because of discomfort, hygiene, and mobility issues [1,21]. One study suggests operative exploration is indicated in a recognized nerve laceration or any open or closed injury that fails to show recovery by clinical or electromyographic examination 3 months or more after injury [22].…”

“…Nerve transfers can be performed with the functioning nerve coapted close to the motor end plate, thus diminishing the regeneration time necessary to reach the motor end plate. The concept of a direct nerve transfer of a tibial motor nerve branch to the deep peroneal nerve as an alternative option to restore ankle dorsiflexion in cases of peroneal nerve injury has been proposed in anatomic studies using cadaveric specimens [1,4,14]. These studies confirm the feasibility of transferring motor nerve branches from the tibial nerve to the peroneal nerve although they did not determine whether the nerve transfer improved strength or function.…”

Peroneal nerve injury associated with sports-related knee injury

“…Most of the 272 patients who had stretch/contusion from high-velocity injuries were involved in motor vehicle accidents. Of 272 stretch/contusion cases, 84 (approximately 30%) were identified as sports-related (Table 1), which included skiing (42 cases), football (23), soccer (8), basketball (6), ice hockey (2), track (2), and volleyball (1). The 84 sports-related peroneal nerve injuries were categorized into those without fracture/dislocation (48 cases) and those with fracture/ dislocation (36 cases).…”