Transsection of the peroneal nerve complicating knee arthroscopy: case report and cadaver study

Isolated Extensor Hallucis Longus Paralysis after Knee Arthroscopy: A case report

“…There were no surgical scars on the proximal lateral aspect of the leg that might be a cause of the injury to the nerve of the EHL. The injury might have occurred at the level of the knee joint where a capsular instrument penetration during meniscectomy was the cause, as reported by some authors 9,10 in addition to a possible high bifurcation of the common peroneal nerve. The peroneal nerve is posterior and deep to the biceps femoris at the level of the joint line, and the inferior lateral geniculate vessels lie along the posterolateral aspect of the capsule at the meniscal attachment.…”

“…Other case reports showed peroneal nerve injury after arthroscopic meniscectomy alone. 9,10 The authors attributed the injury from posterolateral capsular instrument penetration during meniscectomy as evidenced by a scarred posterolateral knee capsule and an unusually high bifurcation above the knee of the common peroneal nerve on reexploration. 10 Deutsch, et al, 15 investigated the anatomic variability of the peroneal nerve bifurcation as a possible risk factor for nerve injury in knee arthroscopy.…”

“…9,10 The authors attributed the injury from posterolateral capsular instrument penetration during meniscectomy as evidenced by a scarred posterolateral knee capsule and an unusually high bifurcation above the knee of the common peroneal nerve on reexploration. 10 Deutsch, et al, 15 investigated the anatomic variability of the peroneal nerve bifurcation as a possible risk factor for nerve injury in knee arthroscopy. They studied the anatomy of the common peroneal nerve bifurcation and noted that in 10% of the 70 cadaveric knees studied; bifurcation was noted to be proximal to the knee joint with an average distance of 7.5 mm.…”

“…4,10,13 Flexion of the knee in 90º or the so-called "figure-of-four" position should be done when arthroscopic instruments approach the posterolateral corner of the knee to decrease the risk nerve injury in cases of capsular penetration since the neurovascular structures are more distant from the knee capsule in this position. 2,5,16 Likewise, caution must be exercised when motorized instruments or arthroscopic forceps are used in the posterolateral aspect of the knee.…”

Peripheral Nerve Injuries in Sports-Related Surgery: Presentation, Evaluation, and Management

“…Arthroscopic lateral meniscectomy and meniscal repair have been specifically identified as procedures associated with risk of injury to the common and deep peroneal nerves. Medial meniscectomy and meniscal repair may place the saphenous nerve at risk for injury or entrapment 13,14,25,26 . The common peroneal nerve lies posterior and deep to the biceps femoris, thereby resulting in particular risk during suture passage in the posterolateral portion of the knee.…”