Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration

Ho, Bryant S.; Khan, Zubair; Switaj, Paul J.; Ochenjele, George; Fuchs, Daniel; Dahl, William J.; Cederna, Paul S.; Kung, Theodore A.; Kadakia, Anish R.

doi:10.1186/s13018-014-0067-6

Cited by 37 publications

(34 citation statements)

References 43 publications

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“…Heik Reichl et al (2013) common peroneal nerve reconstruction is indicated up to 6 months, they described excision of non-conducting neuroma and graft of deep and superfascial nerves by grafts from sural nerve which fixed by 9.0 proline sutures delayed reconstruction of CPN after 13 months from injury time with the case was followed up for 30 months and presented with strength grade 5 and regular pattern of gait with 90 degree active dorsiflexion [12]. Bryant et al (2014): managed (12) cases with peroneal nerve palsy with simultaneous tendone transfer and nerve exploration for (7) cases, with results superior function in all patients compared to dorsiflexion in 40% of cases treated with tendone transfer alone, with 57% of cases treated with both tendone transfer and nerve repair were able to return to running compared to 20% with tendone transfer alone [13]. Although in CPN palsy recover spontaneously in most cases, when irreversible damage to the nerve can occur so introduction of the concept of decision primary or primary & secondary reconstruction intraoperative should be considered.…”

Section: Discussionmentioning

confidence: 99%

Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

2020

ARC Journal of Orthopedics

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Objective: As a result of high risk of failure rate with cases of common peroneal nerve (CPN) palsy with nerve gap defect more than 6cms when managed by sural nerve graft alone so we preferred to proceed directly to tibialis posterior (T P) transfer and sural grafting in one step and evaluate results of common peroneal nerve lesions (CPN) displaying nonfunctional regenerative signs. When explored and Intraoperative decision making to manage the lesions either by primary microsurgical nerve repair or one step primary nerve repair and tibialis posterior transfer reconstructive surgery to provide the patient the best chances of sensory recovery and useful motor functional outcomes. Methods: Forty two patients with common peroneal nerve lesions were managed in Zagazig university hospital (2013-2017), every cases of CPN palsy before surgery, we mentioned the potential of TP transfer during the surgery in one step. 16 cases primary microsurgical nerve repair was done by external neurolysis or internal interfasicular neurolysis. 15 Cases explored, neuroma excision and nerve graft if gap nerve defect less than 6 m with good number of motor end plate evidenced by MUNE of anterior and lateral leg muscles. (11) Cases managed by autologous sural nerve graft and tibialis posterior transfer if gap nerve defect more than 6 m with few number of motor end plate evidenced by MUNE of anterior and lateral leg muscles and viable sensory receptor evidenced by SEVP. Results: The follow up range (20-60) months, patients were satisfied with motor recovery grade (4) and (5) of BMRC, so in (16) cases neurolysis their results were excellent and satisfied in (15/16) (92.5 %). (15) Cases gap defect less than 6 cms were managed with primary nerve repair with sural nerve graft length (3-9 cms) their results were good and satisfied in (12/15) (80%) (11) cases of nerve gap defect more than 6 cm were managed by one step T P tendon transfer and primary nerve repair with sural nerve graft length (9.5-12 cms) their results were excellent and satisfied in (10/11) (90.9). In our study (42) cases with CPN lesions were managed by primary nerve repair or primary nerve repair and secondary TP tendon transfer in one step their motor results were excellent and satisfied in(37/42 , 88.1%), regarding sensory recovery of CPN palsy after our procedures (20) cases described complete sensory recovery (47.6%) and considered excellent results, (17) cases improved sensory deficit (40.4%) and regarded as good results, (5) cases with unchanged sensory deficit (11.9 %) and considered bad result, good and excellent results were considered by the patients as satisfied results. So in our study (37) cases reported satisfied sensory recovery after our procedures (37/42-88.1%). Neuropathic pain was recorded in (16) cases of CPN palsy, after our surgical procedures (6) cases showed complete regression, (7) cases improved with reduction of neuropathic pain, (3) cases recorded as unchanged neuropathic pain and referred to pain control clinic to manage them (13/16 , 81.2 %). Sign...

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Section: Discussionmentioning

confidence: 99%

Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

2020

ARC Journal of Orthopedics

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“…The loss of inversion in these cases has profound clinical significance and eliminates as an option, arguably the best surgical treatment for foot drop, a tibialis posterior tendon transfer. 3,4,6,7 We predicted that this injury may be accounted for by the internal fascicular topographical organization of the sciatic, common peroneal, and tibial nerves.…”

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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“…Over half the patients in the simultaneous group were able to return to running activities compared with only one in the isolated PTT group who was able to do so. 27…”

Section: Tendon Transfers and Arthrodesismentioning

confidence: 99%

Treatment of Peroneal Nerve Injuries in the Multiligament Injured/Dislocated Knee

et al. 2015

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Tibiofemoral knee dislocations are typically a consequence of high-energy mechanisms, causing significant damage to the soft tissue and osseous structures of the knee. Concomitant neurovascular injuries such as popliteal artery and peroneal nerve injuries are also common and can have significant long-term consequences. The mechanism typically involves a traction injury to the peroneal nerve subsequent to an extreme varus moment applied to the knee. Complete nerve injuries typically hold a worse prognosis than incomplete palsies. Rates of functional recovery in the setting of a complete palsy following a knee dislocation event have been dismal. A period of observation and nonoperative treatment is initially performed, utilizing orthotic devices to assist with lower extremity deficits. Surgical treatment options include neurolysis, nerve grafting, tendon transfer, arthrodesis, and direct motor nerve transfers. Motor nerve transfers continue to be explored with initial reports showing promising results.

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Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration

Cited by 37 publications

References 43 publications

Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

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

Treatment of Peroneal Nerve Injuries in the Multiligament Injured/Dislocated Knee

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