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Morphologie : Bulletin de L'Association... Sep 2021Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical...
OBJECTIVE OF THE STUDY
Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical description of the SPN.
MATERIALS AND METHODS
Twenty-three embalmed cadaver lower limbs were dissected.
RESULTS
The SPN emerged from the crural fascia about 6.3±7.7mm anteromedial to the anterior border of the fibula and 26.8±12.6mm anteromedial and 113.6±43.9mm superior to the tip of the lateral malleolus. The median point of bifurcation into two terminal branches was 13.0mm anteromedial to the anterior border of the fibula and 34.9±14.7mm anteromedial and 81.0±69.0mm superior to the tip of the lateral malleolus. The SPN was found between 5.76% and 7.70% of the individual's height proximal to the tip of the lateral malleolus, with an unpredictable branching pattern over the intermalleolar line.
CONCLUSION
A lateral ankle approach over the posterolateral surface of the fibula (posterior to the tip of the lateral malleolus) minimizes the risk of iatrogenic nerve lesion.
Topics: Cadaver; Humans; Iatrogenic Disease; Lower Extremity; Peroneal Nerve
PubMed: 33642180
DOI: 10.1016/j.morpho.2020.09.004 -
American Journal of Orthopedics (Belle... Apr 2014Knee arthroscopy is a common orthopedic procedure that is generally considered relatively safe, with overall complication rates reported between 1% and 8%. Approximately... (Review)
Review
Knee arthroscopy is a common orthopedic procedure that is generally considered relatively safe, with overall complication rates reported between 1% and 8%. Approximately 0.01% to 0.06% of these complications involve neurovascular structures. While peroneal nerve and tibial artery complications are well reported, to our knowledge, injury to the tibial nerve has not been reported. We report a case of injury to the tibial and peroneal nerves during routine meniscal debridement and osteochondral fragment removal in a 17-year-old high school athlete. The likely mechanism of injury was violation of the posterolateral corner by powered arthroscopic instrumentation during the attempt at removal of the loose body. The peroneal nerve was repaired with an interpositional sural nerve graft. Management of these injuries should consist of following patients closely with electromyograms and nerve exploration and repair in those cases that do not show interval improvement. Clinicians should exercise extreme care while using powered instruments in the posterolateral corner.
Topics: Adolescent; Arthroscopy; Debridement; Humans; Intraoperative Complications; Knee Joint; Male; Peroneal Nerve; Tibial Nerve
PubMed: 24730004
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Aug 2014Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of...
BACKGROUND
Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer.
METHOD
We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer.
RESULTS
Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength.
CONCLUSION
The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.
Topics: Adult; Female; Humans; Male; Middle Aged; Peroneal Nerve; Peroneal Neuropathies; Retrospective Studies; Tendon Transfer
PubMed: 25099247
DOI: 10.1186/s13018-014-0067-6 -
Knee Surgery, Sports Traumatology,... Apr 2016To prevent iatrogenic damage to the superficial peroneal nerve during ankle arthroscopy, it needs to be identified. The purpose of the present study was to determine...
PURPOSE
To prevent iatrogenic damage to the superficial peroneal nerve during ankle arthroscopy, it needs to be identified. The purpose of the present study was to determine which clinical test identified the superficial peroneal nerve most frequently and which determinants negatively affected the identification.
METHODS
A total of 198 ankles (99 volunteers) were examined for identification of the superficial peroneal nerve. Race, gender, body mass index (BMI), shoe size and frequency of physical activity were collected.
RESULTS
The best method to identify the superficial peroneal nerve was the maximal combined ankle plantar flexion and inversion test. In this position, the nerve was identified in 57% of the ankles by palpation. BMI was the only independently influential factor in the identification of the superficial peroneal nerve.
CONCLUSION
Since in nearly six out of the ten ankles the superficial peroneal nerve can be identified, it is advised to assess its anatomy prior to portal placement. A higher BMI negatively influences the identification of the superficial peroneal nerve.
LEVEL OF EVIDENCE
Diagnostic study, Level III.
Topics: Adult; Ankle Joint; Female; Humans; Male; Peroneal Nerve; Physical Examination
PubMed: 27017216
DOI: 10.1007/s00167-016-4063-8 -
AJR. American Journal of Roentgenology Oct 2018The objective of this study was to review the anatomy of the superficial peroneal nerve (SPN) and describe the sonographic appearances of various abnormalities affecting...
OBJECTIVE
The objective of this study was to review the anatomy of the superficial peroneal nerve (SPN) and describe the sonographic appearances of various abnormalities affecting it. We performed a retrospective chart review of ultrasound (US) examinations of the SPN performed from 2014 to 2016.
CONCLUSION
SPN abnormalities are well shown on US. Of 181 patients examined with US, the most commonly detected abnormality was scar encasement and neuroma or laceration.
Topics: Adult; Female; Humans; Male; Middle Aged; Peroneal Nerve; Retrospective Studies; Ultrasonography
PubMed: 30063375
DOI: 10.2214/AJR.17.19322 -
Neurosurgical Focus Jan 2018Neurofibromas are benign tumors composed of different cell types from the peripheral nervous system. Neurofibromas infiltrate between nerve fascicles and do not have a...
Neurofibromas are benign tumors composed of different cell types from the peripheral nervous system. Neurofibromas infiltrate between nerve fascicles and do not have a discrete capsule. On MRI, they are T1 hypointense or isointense, T2 hyperintense, often with a "target sign," and contrast enhancing. The video shows gross-total resection of a peroneal nerve neurofibroma presenting as a painful mass in the popliteal fossa. Incisions across a skin crease can be either oblique or zigzag, but never perpendicular to it. It is also key to expose normal nerve proximal and distal to the tumor. The patient had a good functional outcome. The video can be found here: https://youtu.be/G74Zoa1Y2JM .
Topics: Female; Humans; Knee Joint; Middle Aged; Neurofibroma; Peroneal Nerve
PubMed: 29291298
DOI: 10.3171/2018.1.FocusVid.17546 -
Microsurgery 2007Knowledge of the anatomy of the superficial peroneal nerve (SPN) is necessary for surgeons caring for patients with lower extremity pain after ankle, leg, or knee...
Knowledge of the anatomy of the superficial peroneal nerve (SPN) is necessary for surgeons caring for patients with lower extremity pain after ankle, leg, or knee injuries, for athletes with exertional compartment syndrome, and those having reconstructive microsurgery with either soft tissue or vascularized fibular flaps. The anatomy of the SPN is known to be that of a peripheral nerve traveling in the lateral compartment of the lower leg. Recently, clearer descriptions of its variability have documented that between 27 and 43% of patients have the SPN in either the anterior compartment or both the anterior and the lateral compartment of the leg. The present observations record the location of the SPN within the septum that separates the anterior from the lateral compartment. Awareness of this unusual variant location will enable the surgeon to find and preserve the SPN during fasciotomy, neurolysis, neuroma resection, or bony and soft tissue reconstruction.
Topics: Decompression, Surgical; Humans; Microsurgery; Nerve Compression Syndromes; Peroneal Nerve; Retrospective Studies
PubMed: 17596897
DOI: 10.1002/micr.20390 -
Knee Surgery, Sports Traumatology,... Sep 2019The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula.
PURPOSE
The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula.
METHODS
Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values.
RESULTS
The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively.
CONCLUSION
The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.
Topics: Cadaver; Fibula; Humans; Models, Anatomic; Observer Variation; Peroneal Nerve; Reproducibility of Results; Sural Nerve; Tendons
PubMed: 30888450
DOI: 10.1007/s00167-019-05438-x -
Muscle & Nerve Apr 2018We sought to establish the optimal recording position for antidromic conduction of the superficial peroneal nerve (SPN) by using ultrasonography (USG).
INTRODUCTION
We sought to establish the optimal recording position for antidromic conduction of the superficial peroneal nerve (SPN) by using ultrasonography (USG).
METHODS
The sensory nerve action potentials (SNAPs) of the intermediate dorsal cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (MDCN) in 64 limbs of 32 healthy participants were recorded (nerve conduction study [NCS]-1). Both nerves were identified by using USG, and the SNAPs were obtained from the USG-guided repositioned electrodes (NCS-2).
RESULTS
The IDCN and MDCN were located at 29.3% ± 5.1% and 43.9% ± 4.9% of the intermalleolar distance from the lateral malleolus, respectively. Significantly greater amplitude was shown for SNAPs of both nerves in NCS-2 versus NCS-1.
DISCUSSION
The optimal recording position is likely to be lateral, one-third from the lateral malleolus for the IDCN, and just lateral to the midpoint of the intermalleolar line for the MDCN. When the SPN response is unexpectedly attenuated, USG-guided repositioning of the electrodes should be considered. Muscle Nerve 57: 628-633, 2018.
Topics: Action Potentials; Adult; Female; Healthy Volunteers; Humans; Male; Middle Aged; Neural Conduction; Peroneal Nerve; Ultrasonography; Young Adult
PubMed: 28972661
DOI: 10.1002/mus.25978 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Aug 2022Delayed autologous nerve graft reconstruction is inevitable in devastating injuries. Delayed or prolonged repair time has deleterious effects on nerve grafts. We aimed...
BACKGROUND
Delayed autologous nerve graft reconstruction is inevitable in devastating injuries. Delayed or prolonged repair time has deleterious effects on nerve grafts. We aimed improving and accelerating nerve graft reconstruction process in a rat long nerve defect model with loop nerve graft prefabrication particularly to utilize for injuries with tissue loss.
METHODS
Twenty-four Sprague-Dawley rats were allocated into three groups. 1.5 cm long peroneal nerve segment was excised, reversed in orientation, and used as autologous nerve graft. In conventional interpositional nerve graft group (Group 1), nerve defects were repaired in single-stage. In loop nerve graft prefabrication group (Group 2), grafts were sutured end-to-end (ETE) to the proximal peroneal nerve stumps. Distal ends of the grafts were sutured end-to-side to the peroneal nerve stumps 5 mm proximal to the ETE repair sites in first stage. In second stage, distal ends of the prefabricated grafts were transposed and sutured to distal nerve stumps. In staged conventional interpositional nerve graft group (Group 3), grafts were sutured ETE to proximal peroneal nerve stumps in first stage. Distal ends of the grafts and nerve stumps were tacked to the surrounding muscles until the final repair in second stage. Follow-up period was 4 weeks for each stage in Groups 2 and 3, and 8 weeks for Group 1. Peroneal function index (PFI), electrophysiology, and histological assessments were conducted after 8 weeks. P<0.05 was considered significant for statistical analysis.
RESULTS
PFI results of Group 1 (-22.75±5.76) and 2 (-22.08±6) did not show statistical difference (p>0.05). Group 3 (-33.64±6.4) had a statistical difference compared to other groups (p<0.05). Electrophysiology results of Group 1 (16.19±2.15 mV/1.16±0.21 ms) and 2 (15.95±2.82 mV/1.17±0.16 ms) did not present statistical difference (p>0.05), whereas both groups had a statistical difference compared to Group 3 (10.44±1.96 mV/1.51±0.15 ms) (p<0.05). Axon counts of Group 1 (2227±260.4) and 3 (2194±201.1) did not have statistical difference (p>0.05), whereas both groups had significantly poor axon counts compared to Group 2 (2531±91.18) (p<0.05).
CONCLUSION
Loop nerve graft prefabrication improved axonal regeneration without delay. Loop prefabrication can accelerate prolonged regeneration time for the injuries indicating a delayed nerve reconstruction. Higher axon counts derived with loop nerve prefabrication may even foster its investigation in immediate long nerve defect reconstructions in further studies.
Topics: Animals; Nerve Regeneration; Neurosurgical Procedures; Peripheral Nerves; Peroneal Nerve; Rats; Rats, Sprague-Dawley; Sciatic Nerve
PubMed: 35920436
DOI: 10.14744/tjtes.2022.68353