The Distance of the Common Peroneal Nerve to the Posterolateral Structures of the Knee

Jenkins, Michael J.; Farhat, Moussa; Hwang, Peter; Kanawati, Andrew; Graham, Edward

doi:10.1016/j.arth.2016.05.005

Cited by 13 publications

(20 citation statements)

References 11 publications

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“…Clark et al 14 and Jia et al 10 reported the distance between CPN and posterolateral corner of tibial cut surface as 14.9 mm and 14.0 ± 2.7 mm respectively. Jenkins et al 12 calculated the mean distance of 11.9 mm (range, 4.7e22.13 mm) from the posterolateral capsule and concluded that the nerve lies closer to capsule than the tibial border. All the studies have reported significant correlation between the dimensions of the proximal tibia and the distance of the nerve which assumes that surgeons should be careful in patients having small knees ( Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Bruzzone et al 11 described a "danger zone" between lateral edge of popliteus, tibial cut surface and posterior fibers of iliotibial band and advocated against going deep in this region. Jenkins et al 12 determined the mean angle of CPN from the center of AP axis and identified a ''danger zone". between 29.95 and 54.57 from the AP axis as 95% cases CPN lies in this zone.…”

Section: Discussionmentioning

confidence: 99%

“…In all the patients, T-2 weighted TSE axial images at the level of a standard tibial bone "cut" during TKA were examined. The level of tibial bone "cut" was taken as the axial slice approximately 8 mm distal to the articular surface of the lateral tibial plateau which was consistently one or two slices below the joint line which was prescribed by Jenkins et al 12…”

Section: Subjectsmentioning

confidence: 99%

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Assessing the relationship of the peroneal nerve to the posterolateral corner of the knee and influence of race on its dimensions– A MRI based study in Indian population

Sankineani

Dalei

Kumar

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Background: The relationship of Common peroneal nerve (CPN) to the posterolateral corner of the knee joint is important for surgeons who perform total knee arthroplasty to avoid injury to the nerve during surgery. This relationship varies among different races on account of anthropometry. This study aims to evaluate the anatomical location of this nerve in Indian patients using an MRI based reference system. Methods: 213 knee magnetic resonance images (MRIs) were evaluated in axial plane 8 mm below the joint line for distance of the CPN from the closest posterolateral capsule. The angle of the CPN from the center of the tibial anteroposterior axis and relation of CPN with respect to the popliteus were evaluated. A comparative analysis of these measurements among Caucasian, Chinese and Indian patients was made to evaluate for any differences. Results: The mean distance between the CPN and the knee capsule was 15.55 mm (range, 7.8e26.2 mm). The mean angle of the CPN from the center of the AP axis was 50.1 (range, 38e63). CPN was found to be in line with the popliteus from center of the knee in 62% cases. There was no significant difference among the different races among the measured parameters (p > 0.005). Conclusion: This study establishes a "danger zone" and a "safe zone" to avoid CPN injury in total knee arthroplasty in Indian patients and identifies anatomic landmarks to localize the nerve before the softtissues release in order to avoid direct injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

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Assessing the relationship of the peroneal nerve to the posterolateral corner of the knee and influence of race on its dimensions– A MRI based study in Indian population

Sankineani

Dalei

Kumar

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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“…[ 4 ] The common peroneal nerve may be entrapped anywhere along its course, giving rise to the clinical syndrome of peroneal nerve palsy. [ 5 ] Most of the popliteal cysts described in the literature causing peroneal nerve compression were of an intraneural type. [ 6 ] In our case, compression of the common peroneal nerve was due to an extraneural popliteal cyst, a situation rarely encountered.…”

Section: Discussionmentioning

confidence: 99%

Compression neuropathy of common peroneal nerve caused by a popliteal cyst

et al. 2018

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Rationale:Popliteal cyst developing in the sheath of a peripheral nerve or joint capsule may cause compression neuropathy. Although popliteal cyst is very common lesion, it seldom causes serious complications. Common peroneal nerve compression is rarely caused by an extraneural popliteal cyst.Patient concerns:We presented the case of a 52-year-old female with common peroneal nerve compression caused by an extraneural popliteal cyst.Diagnoses:Electromyography showed the damage of common peroneal nerve. MRI magnetic resonance imaging showed the lump to be a popliteal cyst. She was diagnosed as peroneal nerve injury and popliteal cyst.Interventions:The patient was performed peroneal nerve decompression and popliteal cyst excision surgery. We excised the cyst completely and soluted the common peroneal nerve thoroughly. The cyst was filled with thick mucinous material.Outcomes:The pathological report showed that the excised mass was a popliteal cyst. There were no postoperative complications. Pain and hypoesthesia resolved 6 months after surgery.Lessons:In this case, compression of the common peroneal nerve was due to an extraneural popliteal cyst, a situation rarely encountered. MRI can show in better detail their size and internal contents as well as their relation with surrounding anatomic structures. Patients with nerve entrapment caused by enlarged or ruptured cysts must be microsurgically excised if symptomatic.

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“…Common peroneal nerve (CPN) palsy is a serious complication following total knee arthroplasty (TKA), with incidence ranging from 0.3 to 9.5%. [1][2][3] When performing TKA in the valgus knee, the risk has been reported to be higher. 4,5 Although varying depending on the degree of valgus deformity and tightness of the lateral structures, surgeons may usually perform lateral soft tissue release, such as the iliotibial (I-T) band, posterolateral capsule, lateral collateral ligament, and popliteus tendon.…”

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confidence: 99%

Matched-Pair Analysis of Magnetic Resonance Images for Location of the Common Peroneal Nerve in Valgus Knees: Comparison with the Varus Knees

et al. 2020

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This study aimed to assess the distance and angular location of the common peroneal nerve (CPN) on axial magnetic resonance imaging (MRI) in the valgus knees and compare the measurements with those obtained from the control group. We compared the location of the CPN according to the type of alignment by performing a subgroup analysis. From January 2009 to December 2019, we identified 41 knees with preoperative MRI in patients who underwent total knee arthroplasty (TKA) for valgus deformity (valgus group). We performed one-to-two matched-pair analysis to a cohort of patients who underwent MRI but were not candidates for TKA (control group), according to sex and age. The valgus group was classified according to the grading system reported by Ranawat et al, and the control group was also subdivided according to the hip-knee-ankle (HKA) angle obtained from lower extremity scanography: neutral (–3 to +3 degrees from the neutral mechanical axis), valgus (> +3 degrees), and varus alignment (< –3 degrees). Distance between the CPN and posterolateral cortex of the tibia at the knee joint (distance J) and tibial cut level (distance C) were measured. Angle of the CPN from the central anteroposterior axis of the tibia (angle α) was measured. We compared the measurements between the groups. Distance J was significantly closer in the valgus group (p < 0.001), whereas angle α was significantly smaller in the valgus group (p < 0.001). However, no significant differences were found in the subgroup analysis. Moreover, a significant correlation was found between distance J and the HKA angle (p < 0.001). The location of the CPN in the valgus knees was closer to the posterolateral cortex of the tibia at the joint level and showed a smaller angle than that in the other aligned knees. We recommend that lateral soft tissue release for valgus knees should not be performed at the joint line. The results of this study suggest that this would be less safe than a release performed at the level of the proximal tibial bone resection.

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The Distance of the Common Peroneal Nerve to the Posterolateral Structures of the Knee

Cited by 13 publications

References 11 publications

Assessing the relationship of the peroneal nerve to the posterolateral corner of the knee and influence of race on its dimensions– A MRI based study in Indian population

Assessing the relationship of the peroneal nerve to the posterolateral corner of the knee and influence of race on its dimensions– A MRI based study in Indian population

Compression neuropathy of common peroneal nerve caused by a popliteal cyst

Matched-Pair Analysis of Magnetic Resonance Images for Location of the Common Peroneal Nerve in Valgus Knees: Comparison with the Varus Knees

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