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Neurosurgical Focus Jan 2018Peroneal neuropathy is a common pathology encountered by neurosurgeons. Symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the...
Peroneal neuropathy is a common pathology encountered by neurosurgeons. Symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the fibular head, peroneal (fibular) nerve release is a low-risk procedure that can provide excellent results with pain relief and return of function. In this video, the authors highlight key operative techniques to ensure adequate decompression of the nerve while protecting the 3 major branches, including the superficial peroneal nerve, deep peroneal nerve, and recurrent genicular (articular) branches. Key steps include positioning, circumferential nerve dissection, fascial opening, isolation of the major branches, and closure. The video can be found here: https://youtu.be/0y9oE8w1FIU .
Topics: Decompression, Surgical; Humans; Neurosurgical Procedures; Patient Positioning; Peroneal Nerve
PubMed: 29291292
DOI: 10.3171/2018.1.FocusVid.17575 -
Journal of Ultrasound in Medicine :... Apr 2021Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common... (Review)
Review
Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. This Pictorial Essay reviews the normal ultrasound anatomy of the DPN and presents disorders that may involve the nerve and its main branches along its course, from proximal to distal.
Topics: Cadaver; Humans; Peroneal Nerve; Ultrasonography
PubMed: 32881065
DOI: 10.1002/jum.15455 -
JBJS Reviews Jan 2022The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically...
BACKGROUND
The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, although improved surgical technique and novel procedures appear to improve outcomes. Given the variety of underlying injury modalities, treatment options, and prognostic variables, we sought to evaluate and summarize the current literature on traumatic CPN injuries and to provide recommendations from an analysis of the included studies for treatment and future research.
METHODS
A systematic review was performed using PubMed, Embase, and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms consisted of variations of "peroneal nerve" or "fibular nerve" combined with "injury," "laceration," "entrapment," "repair," or "neurolysis." Information with regard to treatment modality, outcomes, and patient demographic characteristics was recorded and analyzed.
RESULTS
The initial search yielded 2,301 articles; 42 met eligibility criteria. Factors associated with better outcomes included a shorter preoperative interval, shorter graft length when an interposed graft was used, nerve continuity, and younger patient age. Gender or sex was not mentioned as a factor affecting outcomes in any study. Motor grades of ≥M3 on the British Medical Research Council (MRC) scale are typically considered successful outcomes. This was achieved in 81.4% of patients who underwent neurolysis, 78.8% of patients who underwent end-to-end suturing, 49.0% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 81.5% of patients who underwent isolated posterior tibial tendon transfer (PTTT), and 84.2% of patients who underwent a surgical procedure with concurrent PTTT.
CONCLUSIONS
Studies included in this review were heterogenous, complicating our ability to perform further analysis. It is not possible to uniformly advocate for the best treatment option, given diverse injury modalities and patient presentations and a variety of prognostic factors. Many studies do not show outcomes with respect to injury modality. Future studies should show preoperative muscle strengths and should clearly define outcomes based on the injury modality and surgical treatment option. This would allow for greater analysis of the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques are promising and should be further explored.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Nerve Transfer; Peripheral Nerve Injuries; Peroneal Nerve; Peroneal Neuropathies; Tendon Transfer
PubMed: 35020680
DOI: 10.2106/JBJS.RVW.20.00256 -
Clinics in Sports Medicine Oct 2020Common peroneal nerve dysfunction after a multiligament knee injury can be devastating. In patients with persistent foot drop, posterior tibial tendon transfer to the... (Review)
Review
Common peroneal nerve dysfunction after a multiligament knee injury can be devastating. In patients with persistent foot drop, posterior tibial tendon transfer to the dorsum of the foot is a reliable and safe procedure to restore dorsiflexion. These authors favor passing the posterior tibial tendon through the interosseous membrane and docking it into the lateral/middle cuneiforms. A Strayer procedure or tendo-Achilles lengthening must be performed in patients unable to achieve at least 10° of passive dorsiflexion. Despite the operative limb having 30% to 40% of ankle dorsiflexion strength of the uninjured limb, short- and long-term functional outcomes are excellent.
Topics: Humans; Knee Injuries; Peripheral Nerve Injuries; Peroneal Nerve; Tendon Transfer; Treatment Outcome
PubMed: 32892969
DOI: 10.1016/j.csm.2020.07.003 -
Archives of Orthopaedic and Trauma... Jul 2019Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the...
INTRODUCTION
Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau.
METHODS
The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks.
RESULTS
The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68.
CONCLUSION
As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.
Topics: Aged; Anatomy, Regional; Cadaver; Female; Humans; Imaging, Three-Dimensional; Intraoperative Complications; Leg; Male; Orthopedic Procedures; Peripheral Nerve Injuries; Peroneal Nerve; Radiography
PubMed: 30737594
DOI: 10.1007/s00402-019-03141-7 -
Journal of Clinical Neuroscience :... Aug 2020Different mechanisms including knee dislocation, replacement surgery, nerve tumor, lumbar disc herniation, sharp injury, and gunshot wound lead to foot drop. Several...
Different mechanisms including knee dislocation, replacement surgery, nerve tumor, lumbar disc herniation, sharp injury, and gunshot wound lead to foot drop. Several surgical techniques have been used for treatment of foot drop, however, they have had sub-optimal outcomes. Soleus branch of tibial nerve is a good donor for nerve transfer for treatment of foot drop. In this is retrospective study, we reviewed medical records of 6 consecutive patients with sustained foot drop following injury to lumbar root or peroneal nerve, who underwent transfer of the soleus branch of tibial nerve to deep peroneal nerve during 2014-2016. The mean age of the patients was 44.8 years and duration of injury to surgery and follow-up was 8.3 and 14.6 months, respectively. At the end of the follow-up, ankle dorsiflexion force was M4 in two patients (with traumatic peroneal nerve injury with M3 toe extension) and was M2 in one patient. There were three patients with lumbar degenerative disease. Of these patients, two showed M0 and one patient experienced M1 ankle dorsiflexion. We recommend that transfer of soleus nerve to deep peroneal nerve is used as an alternative technique for treatment of foot drop.
Topics: Adult; Female; Humans; Male; Middle Aged; Nerve Transfer; Peripheral Nerve Injuries; Peroneal Nerve; Peroneal Neuropathies; Retrospective Studies
PubMed: 32336637
DOI: 10.1016/j.jocn.2020.04.086 -
Acta Neurochirurgica Sep 2019To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck.
OBJECTIVE
To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck.
METHODS
The thread common peroneal nerve release was performed on 15 fresh frozen cadaveric lower extremity specimens. All procedures were performed under ultrasound guidance and immediately underwent post-procedural gross anatomic inspection for completeness of decompression and presence or absence of iatrogenic neurovascular injury.
RESULTS
All 15 specimens demonstrated complete transection of the deep fascia of the peroneus longus overlying the common peroneal nerve. The transections extended to the bifurcation of the superficial peroneal and deep peroneal nerves. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 30 min.
CONCLUSION
This cadaveric validation study demonstrates the accuracy of the thread common peroneal nerve release. Future pilot studies are warranted to ensure the safety of this procedure in the clinical setting.
Topics: Cadaver; Decompression, Surgical; Humans; Leg; Neurosurgical Procedures; Peroneal Nerve; Peroneal Neuropathies; Surgery, Computer-Assisted; Ultrasonography
PubMed: 31270613
DOI: 10.1007/s00701-019-03998-y -
The Journal of Foot and Ankle Surgery :... 2016
Review
Topics: Decompression, Surgical; Female; Humans; Injury Severity Score; Male; Nerve Compression Syndromes; Neurosurgical Procedures; Peripheral Nerve Injuries; Peroneal Nerve; Recovery of Function; Treatment Outcome
PubMed: 26878807
DOI: 10.1053/j.jfas.2015.11.005 -
Medicina (Kaunas, Lithuania) Jun 2023: The arthroscopic Broström procedure is a promising treatment for chronic ankle instability. However, little is known regarding the location of the intermediate...
: The arthroscopic Broström procedure is a promising treatment for chronic ankle instability. However, little is known regarding the location of the intermediate superficial peroneal nerve at the level of the inferior extensor retinaculum; knowledge about this location is important for procedural safety. The purpose of this cadaveric study was to clarify the anatomical relationship between the intermediate superficial peroneal nerve and the sural nerve at the level of the inferior extensor retinaculum. : Eleven dissections of cadaveric lower extremities were performed. The origin of the experimental three-dimensional axis was defined as the location of the anterolateral portal during ankle arthroscopy. The distances from the standard anterolateral portal to the inferior extensor retinaculum, sural nerve, and intermediate superficial peroneal nerve were measured using an electronic digital caliper. The location of inferior extensor retinaculum, the tract of sural nerve, and intermediate superficial peroneal nerve were checked using average and standard deviations. For the statistical analyses, data are presented as average ± standard deviation, and then they are reported as means and standard deviations. Fisher's exact test was used to identify statistically significant differences. : At the level of the inferior extensor retinaculum, the mean distances from the anterolateral portal to the proximal and distal intermediate superficial peroneal nerve were 15.9 ± 4.1 (range, 11.3-23.0) mm and 30.1 ± 5.5 (range, 20.8-37.9) mm, respectively. The mean distances from the anterolateral portal to the proximal and distal sural nerve were 47.6 ± 5.7 (range, 37.4-57.2) mm and 47.2 ± 4.1 (range, 41.0-51.8) mm), respectively. : During the arthroscopic Broström procedure, the intermediate superficial peroneal nerve may be damaged by the anterolateral portal; the proximal and distal parts of the intermediate superficial peroneal nerve were located within 15.9 and 30.1 mm, respectively, at the level of the inferior extensor retinaculum in cadavers. These areas should be considered danger zones during the arthroscopic Broström procedure.
Topics: Humans; Lateral Ligament, Ankle; Peroneal Nerve; Ankle Joint; Ankle; Cadaver
PubMed: 37374313
DOI: 10.3390/medicina59061109 -
Clinical Neurology and Neurosurgery Oct 2021Intraneural ganglia are benign fluid-filled cysts contained within the subepineurial space of peripheral nerves. The common peroneal nerve at the fibular neck is by far... (Review)
Review
OBJECTIVES
Intraneural ganglia are benign fluid-filled cysts contained within the subepineurial space of peripheral nerves. The common peroneal nerve at the fibular neck is by far the most frequently involved, although other nerves can be affected as well. Although the differential diagnosis of foot drop in adults and children show some differences, clinical presentation, diagnostic workup, treatment and follow-up of intraneural ganglia are quite similar in both groups. The primary objective was to create an overview of intraneural ganglia in children, with an emphasis on diagnostic workup and potential pitfalls during neurosurgical intervention, based on all available literature concerning this topic and own center experiences. As a secondary objective, we tried to raise the awareness concerning this unique cause of foot drop in childhood.
PATIENTS AND METHODS
We performed a review of the literature, in which children who developed foot drop secondary to an intraneural ganglion cyst of the common peroneal nerve were examined. A total of eleven articles obtained from MEDLINE were included. Search terms included: "pediatric", "children", "child", "intraneural ganglia", "intraneural ganglion cysts", "foot drop", "peroneal nerve" and "fibular nerve". Additional studies were identified by checking reference lists. Furthermore, we present the case of a 12-year old girl with foot drop caused by an intraneural ganglion cyst. She underwent cyst decompression with evacuation of intraneural cyst fluid and articular branch disconnection. PRISMA and CARE statement guidelines were followed.
RESULTS
We hypothesize that minor injury caused a breach in the joint capsule, resulting in synovial fluid egression along the articular nerve branch, corroborating the unifying articular theory and emphasizing the need for ligation of said branch. Foot drop is a predominant characteristic, explained by the proximity of the anterior tibial muscle motor branch near the articular branch nerve. In children, satisfactory motor recovery after surgical decompression is to be expected.
CONCLUSION
Sudden or progressive foot drop in children warrants an exhaustive neurophysiological and radiological workup. The management of intraneural ganglia is specific, consisting of nerve decompression, articular branch ligation and joint disarticulation, if deemed necessary. Our surgical results support the unifying articular theory and emphasize the importance of ligation and transection of the articular branch nerve, distally from the anterior tibial muscle branch, in order to prevent intraneural ganglia recurrence. This well-documented case adds depth to the current literature on this sparsely reported entity.
Topics: Child; Female; Ganglion Cysts; Humans; Magnetic Resonance Imaging; Peroneal Nerve; Peroneal Neuropathies
PubMed: 34500339
DOI: 10.1016/j.clineuro.2021.106915