Contralateral Obturator Nerve to Femoral Nerve Transfer for Restoration of Knee Extension After Acute Flaccid Myelitis

Abstract

Case: A 7-year-old boy presented with left femoral and obturator nerves (ONs) palsy after an asthmatic attack with a viral prodrome, and his right lower limb was unaffected. He was diagnosed with acute flaccid myelitis (AFM) after positive spinal magnetic resonance imaging findings. After contralateral ON to femoral nerve transfer (CONFNT), his left quadriceps was reinnervated at 5.5 months, full knee extension was recovered at 14 months, and good functional outcomes were achieved at 31 months. Conclusions: This first clinical report on CONFNT demonstrated a feasible good alternative in treating young patients with AFM with unilateral L2-L4 palsy and short duration of deficit.

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

“…After removal of duplicates and initial screening, 500 were reviewed and assessed for eligibility. After application of inclusion and exclusion criteria, 99 articles were included in this study (55 case reports/series, 1,4–7,9–57 33 retrospective cohort studies, 2,3,58–88 seven cross-sectional studies, 89–95 and four case-control studies 96–99 ) (Fig. 1).…”

“…6,45 Although studies are limited, the early literature provides compelling evidence that nerve transfers are beneficial for patients with persistent weakness secondary to AFM. 6,19,30,45,59,64,[66][67][68] Although not all patients experienced significant improvement in all muscle groups, 72.1% of patients analyzed in this review had improvement in at least one muscle group after nerve transfer surgery, with many patients experiencing significant improvement (Table 1). In addition, in one study that used social media surveys, 75% of parents of patients with AFM reported subjective recovery after nerve transfers, and 100% of them would recommend the procedure.…”

Contralateral Obturator to Femoral Nerve Branch Transfer for Multilevel Lumbosacral Plexus Avulsion Injury

“…A direct contralateral obturator to femoral nerve transfer has been reported in a 7-year-old boy for restoration of knee extension after acute flaccid myelitis. 7 Another case was reported in a young adult. 8 Table 1 summarizes published surgical interventions for extensive lumbosacral plexus injuries with no available ipsilateral donors.…”

Functional reconstruction of lower extremity nerve injuries

“…The technique usually involves transferring the gracilis branch to a large motor division supplying the rectus femoris and vastus lateralis, primarily [Figure 4]. Variations in number of donor and recipient branches, sub-muscular vs. supra-muscular tunneling over the adductor longus, and use of contralateral obturator nerve have been described [32,33] . While other potential donor nerves, such as the nerve to the tensor fascia lata (TFL) and the sciatic nerve can be considered when the obturator nerve is not available, our experience supports the obturator nerve as a reliable donor for achieving functional knee stability and extension and negligible donor morbidity.…”