-
Journal of Plastic, Reconstructive &... Oct 2021Common peroneal nerve (CPN) injury is a recognised complication of traumatic knee dislocation with a direct association between the degree of ligamentous injury and the...
Common peroneal nerve (CPN) injury is a recognised complication of traumatic knee dislocation with a direct association between the degree of ligamentous injury and the degree of CPN injury. It is essential explore and repair these injuries in good time to reduce morbidity. Often exploration only involves the portion of this nerve associated with the joint as it courses around the fibular head. However, a recent case highlighted the importance of proximal exploration to its branching point from the sciatic nerve, a known point of fragility, even if other defects have been identified.
Topics: Adult; Athletic Injuries; Bicycling; Humans; Knee Dislocation; Knee Injuries; Male; Neurosurgical Procedures; Patient Care Team; Peripheral Nerve Injuries; Peroneal Nerve; Plastic Surgery Procedures; Time-to-Treatment; Trauma Severity Indices; Treatment Outcome
PubMed: 34229957
DOI: 10.1016/j.bjps.2021.05.063 -
The Journal of Foot and Ankle Surgery :... 2006The purpose of this study is to refine further the knowledge about the anatomic variability of the superficial peroneal nerve in the middle third of the leg. Approaching...
The purpose of this study is to refine further the knowledge about the anatomic variability of the superficial peroneal nerve in the middle third of the leg. Approaching the superficial peroneal nerve in this location is required: 1) when either the deep or the superficial peroneal nerve must be resected for the treatment of dorsal foot pain; 2) when a neurolysis of the superficial peroneal nerve is required; 3) when a fasciotomy must be performed either for trauma or for exertional compartment syndrome surgery; and 4) during elevation of a fasciocutaneous or fibular flaps. Because of the variability encountered during these procedures, a prospective study was carried out via lower extremity cadaver dissection with fresh, frozen specimens. A total of 35 nonpaired lower extremities and 40 paired lower extremities were dissected with 3.5 loupe magnification. The superficial peroneal nerve was identified in the lateral compartment immediately adjacent to the fascial septum in 72% of the specimens (54 of 75), with a branch in both the anterior and the lateral compartment in 5% of the specimens (4 of 75), and located in the anterior compartment in only 23% of the specimens (17 of 75). The clinical implications of these anatomic findings are that the surgeon operating in the anterior and lateral compartments of the leg should be aware that the superficial peroneal nerve may be located in the lateral compartment and may also exhibit branches in both the anterior and lateral compartments.
Topics: Adult; Cadaver; Humans; Lower Extremity; Peroneal Nerve
PubMed: 16651197
DOI: 10.1053/j.jfas.2006.02.004 -
Plastic and Reconstructive Surgery May 2021Although there was initial success using tibial nerve transfer to restore ankle dorsiflexion following peroneal nerve injury, results from later series were less...
BACKGROUND
Although there was initial success using tibial nerve transfer to restore ankle dorsiflexion following peroneal nerve injury, results from later series were less promising. A potential reason is coactivation of the much stronger antagonistic muscles during gait. The purpose of this study was to test the hypothesis that gait training would improve functional performance following tibial nerve transfer.
METHODS
Using a prospective, nonrandomized, controlled study design, patients were divided into two groups: surgery only or surgery plus gait training. Of the 20 patients who showed reinnervation in the tibialis anterior muscle, 10 were assigned to the gait training group, and an equal number were in the control group. Those in the treatment group began training once reinnervation in the tibialis anterior muscle was detected, whereas those in the control group continued to use their ankle-foot orthosis full time. Differences in ankle dorsiflexion were measured using the Medical Research Council scale, and quantitative force measurement and functional disability was measured using the Stanmore Scale.
RESULTS
Patients in the gait training group attained significantly better functional recovery as measured by the Stanmore Scale (79.5 ± 14.3) (mean ± SD) versus (37.2 ± 3.5) in the control group (p = 0.02). Medical Research Council grades were 3.8 ± 0.6 in the training group versus 2.5 ± 1.2 in the surgery only group (p < 0.05). Average dorsiflexion force from patients with above antigravity strength (all from the training group) was 31 percent of the contralateral side.
CONCLUSION
In patients with successful reinnervation following tibial nerve transfers, rehabilitation training significantly improved dorsiflexion strength and function.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, II.
Topics: Adult; Female; Gait; Humans; Male; Nerve Transfer; Non-Randomized Controlled Trials as Topic; Peroneal Nerve; Prospective Studies; Recovery of Function; Tibial Nerve; Treatment Outcome; Young Adult
PubMed: 33835089
DOI: 10.1097/PRS.0000000000007896 -
The Journal of Foot and Ankle Surgery :... 2015Ankle arthroscopic procedures offer less postoperative morbidity with faster healing times than open surgical procedures but still have associated risks. Complication...
Ankle arthroscopic procedures offer less postoperative morbidity with faster healing times than open surgical procedures but still have associated risks. Complication rates as high as 17% have been reported. One of the most commonly reported complications is iatrogenic damage to the superficial peroneal nerve, which can result in numbness, tingling, or painful neuralgia. In the present study, we attempted to better assess the location of the superficial peroneal nerve at the ankle to improve preoperative planning and reduce complication rates. Fifty ankle specimens were dissected. A concerted effort was made to classify the location of the superficial peroneal nerve according to the Takao branching pattern, zones of the ankle, and distance to anatomic landmarks. Through our dissections, we found that most ankles have 2 nerve branches at the level of the ankle joint (Takao type II) and that the location of the superficial peroneal nerve branches at the ankle correlated directly with the ankle width. Additionally, 68% of specimens contained a nerve branch located in zone 1, where the anterolateral portal is placed, and 12% had a branch in zone 5, the location of the anteromedial portal site. The results of the present study have confirmed the wide variation in nerve location at the level of the ankle joint and serve to highlight the need for extreme caution during surgical procedures at the ankle.
Topics: Aged; Aged, 80 and over; Ankle Joint; Arthroscopy; Cadaver; Female; Humans; Male; Middle Aged; Peroneal Nerve; Postoperative Complications
PubMed: 25262839
DOI: 10.1053/j.jfas.2014.07.002 -
Archives of Orthopaedic and Trauma... Mar 2021The common peroneal nerve (CPN) can be injured during fibular-based posterolateral reconstructions due to its close relationship to the neck of the fibula. Therefore,...
The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions.
PURPOSE
The common peroneal nerve (CPN) can be injured during fibular-based posterolateral reconstructions due to its close relationship to the neck of the fibula. Therefore, the purpose of this study was to observe the course of the CPN and its branches around the fibular head and neck and quantify the position in relation to relevant bony landmarks and observe the relation between tunnel drilling for posterolateral corner reconstruction and both the tunnel entry and exit at the proximal fibula and the CPN and its branches was observed.
METHODS
In 101 (mean age = 70.6 ± 16 years) embalmed cadaver knees, the relationship between bony landmarks (tibial tuberosity, styloid process of fibula (APR)) and the CPN and its branches were established and 8 (M1-M8) distances from these landmarks measured; mean, SD and 95% CI were recorded. In 21 of these knees, a fibula tunnel was drilled as in PLC reconstruction and the association of the CPN and its branches to the tunnel entry and exit were judged by two independent observers. Fisher's exact test of independence was used to determine significant differences between genders. Tunnel intersection was analysed in a binary yes/no fashion and was described in frequencies and percentages.
RESULTS
The mean distance from the APR to where the CPN reaches the fibula neck (M1) was 31.4 ± 8.9 mm (CI:29.8-33.0); from the apex of the styloid process (APR) to where the CPN passes posterior to the broadest point of the fibular head (M3) was 21.7 ± 12.6 mm (CI:19.4-24.0); from the apex of the APR to the most proximal point of the CPN/CPN first branch in the midline of the fibular head (M2) was 37.0 ± 6.7 mm (CI: 35.4-37.7). Out of the 21 randomly selected knees for drilling, the first branch of the CPN was damaged at the tunnel entry point in 7 (33%), and in 5 knees (24%), the CPN was damaged at the tunnel exit. In one knee, at both the tunnel entry and exit, the first branch of the CPN and the CPN were intersected, respectively.
CONCLUSION
The results of this study strongly suggest that the CPN is at risk when drilling the fibula tunnel performing fibula-based posterolateral corner reconstructions. The total injury rate was 57% with a 33% incidence of injury to the first branch of the nerve at the tunnel entry and 24% to the CPN at the tunnel exit.
CLINICAL RELEVANCE
Due to the high incidence of injury, percutaneous placement of guide pins and tunnel drilling is not recommended. The nerve should be visualized and protected by either a traditional open approach or minimally invasive techniques. With a minimally invasive approach, the nerve should be identified at the fibula neck and then followed ante- and retrograde.
Topics: Aged; Aged, 80 and over; Fibula; Humans; Middle Aged; Peripheral Nerve Injuries; Peroneal Nerve; Postoperative Complications; Plastic Surgery Procedures
PubMed: 33392754
DOI: 10.1007/s00402-020-03708-9 -
British Journal of Neurosurgery Apr 2017The anatomical surface markings for the superficial peroneal nerve have been described and it may be preferred for biopsy in cases of suspected vasculitis as biopsy of...
The anatomical surface markings for the superficial peroneal nerve have been described and it may be preferred for biopsy in cases of suspected vasculitis as biopsy of the peroneus brevis muscle increases diagnostic yield. The procedure is however unfamiliar to many surgeons and the anatomical variability of the subcutaneous part underestimated. Where the nerve has some preserved sensory nerve action potential it may be mapped pre-operatively, greatly facilitating minimally traumatic biopsy with potential logistical and wound healing advantages. We review the literature relating to the anatomical course of the nerve and present a case illustrating the advantages of pre-operative mapping, given its location in the anterior compartment of the leg 26% of the time.
Topics: Action Potentials; Anesthesia, Local; Biopsy; Humans; Neural Conduction; Peroneal Nerve; Ultrasonography
PubMed: 27760484
DOI: 10.1080/02688697.2016.1244256 -
Knee Surgery, Sports Traumatology,... 2000Peroneal nerve palsy following knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal...
Peroneal nerve palsy following knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal nerve function. We describe peroneal nerve pathoanatomy in three patients in whom late exploration of the peroneal nerve was performed because of ongoing absence of ankle dorsiflexion. We identified frank nerve rupture in two patients and a lengthy neuroma in continuity in one which extended far proximal to the fibular head and well above the previous surgical incision used for peroneal nerve neurolysis at the time of knee reconstruction. In light of the current state of microneural surgery and the potential to reconstruct nerve defects, we discuss how our findings impact on treatment, and provide recommendations which may improve recovery of peroneal nerve function in future cases.
Topics: Adult; Anterior Cruciate Ligament Injuries; Humans; Joint Dislocations; Knee Injuries; Male; Paralysis; Peroneal Nerve; Peroneal Neuropathies; Rupture
PubMed: 10883428
DOI: 10.1007/s001670050208 -
American Journal of Physical Medicine &... Aug 1990Ankle or foot pain may be due to various clinical conditions. Injury or entrapment of the deep peroneal sensory nerve is part of the differential diagnosis; however, no...
Ankle or foot pain may be due to various clinical conditions. Injury or entrapment of the deep peroneal sensory nerve is part of the differential diagnosis; however, no technique studying the deep peroneal sensory conduction velocity has been described. We describe a technique that is simple and reproducible with averaging. We electrophysiologically studied the deep peroneal sensory nerve in 40 neurologically healthy adult subjects. The latency to onset of the sensory action potential was 2.9 +/- 0.4 ms (range = 2.1-3.6 ms). The latency to the peak of the sensory action potential was 3.6 +/- 0.4 ms (range = 2.7-4.2 ms). The conduction velocity was 42 +/- 5 m/s (range = 33-53 m/s). The amplitude was 3.4 +/- 1.2 microV (range = 1.6-6.6 microV). We conclude that the deep peroneal sensory nerve is readily accessible for electrophysiologic evaluation. It may be of value in diagnosing deep peroneal nerve pathology.
Topics: Action Potentials; Adult; Electrodes; Electrodiagnosis; Electrophysiology; Evoked Potentials; Female; Humans; Male; Neural Conduction; Peroneal Nerve; Reaction Time
PubMed: 2383381
DOI: 10.1097/00002060-199008000-00006 -
Knee Surgery, Sports Traumatology,... May 2010Despite the fact that the superficial peroneal nerve is the only nerve in the human body that can be made visible; iatrogenic damage to this nerve is the most frequently...
Despite the fact that the superficial peroneal nerve is the only nerve in the human body that can be made visible; iatrogenic damage to this nerve is the most frequently reported complication in anterior ankle arthroscopy. One of the methods to visualize the nerve is combined ankle plantar flexion and inversion. In the majority of cases, the superficial peroneal nerve can be made visible. The portals for anterior ankle arthroscopy are however created with the ankle in the neutral or slightly dorsiflexed position and not in combined plantar flexion and inversion. The purpose of this study was to undertake an anatomical study to the course of the superficial peroneal nerve in different positions of the foot and ankle. We hypothesize that the anatomical localization of the superficial peroneal nerve changes with different foot and ankle positions. In ten fresh frozen ankle specimens, a window, only affecting the skin, was made at the level of the anterolateral portal for anterior ankle arthroscopy in order to directly visualize the superficial peroneal nerve, or if divided, its terminal branches. Nerve movement was assessed from combined 10 degrees plantar flexion and inversion to 5 degrees dorsiflexion, standardized by the Telos stress device. Also for the 4th toe flexion, flexion of all the toes and for skin tensioning possible nerve movement was determined. The mean superficial peroneal nerve movement was 2.4 mm to the lateral side when the ankle was moved from 10 degrees plantar flexion and inversion to the neutral ankle position and 3.6 mm to the lateral side from 10 degrees plantar flexion and inversion to 5 degrees dorsiflexion. Both displacements were significant (P < 0.01). The nerve consistently moves lateral when the ankle is manoeuvred from combined plantar flexion and inversion to the neutral or dorsiflexed position. If visible, it is therefore advised to create the anterolateral portal medial from the preoperative marking, in order to prevent iatrogenic damage to the superficial peroneal nerve.
Topics: Aged; Aged, 80 and over; Ankle Joint; Arthroscopy; Female; Humans; Male; Middle Aged; Patient Positioning; Peroneal Nerve
PubMed: 20224993
DOI: 10.1007/s00167-010-1099-z -
Journal of Anatomy Feb 1999Neurotisation involves transfer of nerves for the restoration of function following injury. A number of nerves have been used in different part of the peripheral nervous...
Neurotisation involves transfer of nerves for the restoration of function following injury. A number of nerves have been used in different part of the peripheral nervous system. This study was undertaken to develop a practical and relatively safe surgical approach to the treatment of L4 root lesion's. We examined the effectiveness and safety of neurotisation of the deep peroneal nerve and its branches by the superficial peroneal nerve. Twelve legs of dissected cadavers provided for teaching purposes in the anatomy laboratory were used to display the common peroneal nerve and its branches. Each branch was measured using calipers and analysed to investigate the possibility of neurotisation of the deep peroneal nerve by the superficial peroneal nerve and its branches. It was found that of the measured branches, transposition was possible between those to peroneus longus and tibialis anterior on the basis of their diameter and length. In recent decades, advances in microsurgical reconstruction and understanding of the microanatomy have played major roles in improving the results of surgical treatment of nerve injuries. There is a need for further experimental studies on the feasibility of this surgical approach.
Topics: Dissection; Humans; Nerve Regeneration; Peroneal Nerve
PubMed: 10337964
DOI: 10.1046/j.1469-7580.1999.19420309.x