A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation

Woodmass, Jarret M.; Romatowski, Nicholas P J; Esposito, John G.; Mohtadi, Nicholas G.; Longino, Peter David

doi:10.1007/s00167-015-3676-7

Cited by 74 publications

(55 citation statements)

References 28 publications

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“…20 These findings are similar to other studies showing a higher incidence of neurovascular injury with more severe MLKIs and again should alert clinicians to the likelihood of these injuries occurring together. 1,6,7,11 Although the difference in rate of return to work for patients with concurrent peroneal nerve injury (73%) versus those without nerve injury (81%) was not statistically significant, the authors suggest that the difference is clinically significant and should be communicated to patients. More than 25% of patients with a concurrent peroneal nerve injury did not return to full duty at work after surgical reconstruction of their injured knee.…”

Section: Discussionmentioning

confidence: 98%

“…Multiligament knee injuries (MLKIs) are an infrequent, yet serious injury, and concurrent common peroneal nerve (CPN) injuries have been reported to occur in 5% to 40% of patients with a MLKI. [1][2][3][4][5][6] Several studies have reported a greater incidence of CPN injury with high-velocity mechanisms of injury, open dislocations, and dislocations with a posterolateral corner (PLC) injury. 2,[5][6][7][8] Recovery and outcomes of CPN injuries have been reported to be poor in some studies, with less than one-third of patients regaining the ability to dorsiflex the ankle.…”

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confidence: 99%

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Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

Worley

Brimmo

Nuelle³

et al. 2018

J Knee Surg

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The purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0-117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty ( = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity ( = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; = 0.17), Lysholm score (mean 88.6 vs. 88.8; = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower ( = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

Worley

Brimmo

Nuelle³

et al. 2018

J Knee Surg

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“…The incidence of common peroneal nerve (CPN) injury following acute traumatic dislocation is between 10% and 40% . Complete CPN palsy may recover after a period of time but may remain irreversible once foot drop is present …”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging for common peroneal nerve injury in trauma patients: Are routine knee sequences adequate for prediction of outcome?

et al. 2018

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Introduction: Common peroneal nerve (CPN) injury occurs in 10-40% of patients following knee dislocation. Is magnetic resonance imaging (MRI) using routine knee protocols able to adequately evaluate CPN injury and predict long-term outcome? Methods: Trauma patients presenting for knee MRI at a single public hospital, between July 2007 and May 2017, were retrospectively identified using radiology and orthopaedic databases. Medical records were retrieved for clinical scores. MRI images were scored by two independent radiologists blinded to the clinical CPN status and scores correlated with initial clinical scores using the Pearson correlation coefficient. Results: Final cohort included 107 patients (81 males and 26 females) with a mean age of 39 (range 19-81 years). MRI was considered to be adequate for coverage of the CPN in 84 patients. Fourteen patients had CPN injury clinically (seven complete and seven partial). Concordance between MRI scores and initial clinical scores was 0.456 (P = 0.01). MRI sensitivity and specificity for CPN injury on the 84 adequate scans were 54.5% and 93.2% respectively. All seven cases of partial CPN injury and three of seven cases of complete CPN injury recovered fully. High MRI scores of 5 and 8 were given for the two patients with a persisting complete CPN palsy. Highest scores for partial CPN injury subjects were 2 and 4. Conclusions: Magnetic resonance imaging using a routine knee protocol is not adequate for the assessment of CPN injury in many subjects. More specific MRI neural sequences with complete CPN coverage may be worth trialing.

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“…CPN injury is an important complicating factor in the setting of knee dislocation, having deleterious effects on function, neuropathic pain, and the overall quality of life [6] . Patients who suffer from a persistent foot drop have significantly worse functional outcomes [7,8] . CPN injury can be diagnosed clinically, although a high index of suspicion is needed.…”

Section: Resultsmentioning

confidence: 99%

Risk factors for common peroneal nerve injury in knee dislocation: a retrospective study

Tan

wang

liu

et al. 2020

Preprint

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Background Knee dislocation is a serious injury, representing less than 0.2% of all orthopedic injuries, and 16% to 40% of these patients suffer an associated injury to the common peroneal nerve (CPN). However, it is still unclear which structures are most intently associated with CPN injury. This study attempts to analyze the potential risk factors for CPN injury and provide clues for a comprehensive diagnosis of knee dislocation. Methods We retrospectively reviewed 153 cases of knee dislocation related to lateral and/or posterior ligament injury between 2015 and 2018. All 153 patients were divided into the CPN injury group or the no-CPN injury group. The baseline characteristics included age, gender, cause of injury, posterior cruciate ligament (PCL) disruption, anterior cruciate ligament (ACL) disruption, popliteofibular ligament and/or tendon of popliteus injury, biceps femoris tendon injury and fibular head fracture. We identified potential variables for a multivariable logistic regression model to identify the major risk factors for CPN injury. Results Multivariate regression analysis revealed the biceps femoris tendon injury and fibular head fracture to be predictive of CPN injury in knee dislocation. Gender, age, cause of injury, ligamentous classification, popliteofibular ligament and/or tendon of popliteus injury, PCL disruption or ACL disruption do not predict CPN injury. Conclusions Biceps femoris tendon injury and fibular head fracture are risk factors of CPN injury in knee dislocation. A better understanding of the risk factors for CPN injury allows surgeons to achieve more accurate diagnoses.

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A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation

Cited by 74 publications

References 28 publications

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

Magnetic resonance imaging for common peroneal nerve injury in trauma patients: Are routine knee sequences adequate for prediction of outcome?

Risk factors for common peroneal nerve injury in knee dislocation: a retrospective study

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