Drop Foot After Knee Dislocation: Evaluation and Treatment

Cush, Gerard J.; Maloney, Patrick J.; Irgıt, Kaan

doi:10.1007/978-0-387-49289-6_24

Cited by 23 publications

(32 citation statements)

References 57 publications

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“…4,5,10,15 Nearly onehalf of patients with nerve involvement may have a permanent deficit, and results of surgical repair have typically been modest, especially with longer grafts. 11,15,19,23,26,30 Increased prevalence of CPN palsy is associated with higher velocity injury mechanisms, 5,21 knee dislocations with posterior cruciate ligament and posterolateral corner injuries, 15 and increased BMI.…”

Section: Discussion Common Peroneal Nerve Injurymentioning

confidence: 99%

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Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1–4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.

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Section: Discussion Common Peroneal Nerve Injurymentioning

confidence: 99%

“…Common peroneal nerve (CPN) palsy has been reported in 25%-40% of cases. 4,5,10,15 The mechanism has been thought to be a stretch lesion to the posterolateral aspect of the knee. 24 Because of the broad zone of injury seen clinically, patients often fare poorly and do not recover either spontaneously or even when treated with long interpositional grafts.…”

mentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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“…M or L is medial or lateral sided injury, respectively. Surgical procedure details the use of allograft, autograft and/or repair, and their associated combinations literature, from 4 to 50 % [6,9,14,25,29]. Although there is a wide variety in the reported incidence of these injuries in the literature, a recent systematic review performed by Medina et al [22] identified 862 patients with knee a known knee dislocation, of whom 171 sustained vascular injury (18 %) The frequency of nerve injuries after knee dislocation was 75 of 272 (25 %).…”

Section: Neurovascular Complicationsmentioning

confidence: 99%

Surgical treatment of multiligament knee injuries

Cook

Ridley

McCarthy

et al. 2014

Knee Surg Sports Traumatol Arthrosc

103

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“…Peroneal nerve palsy is a frequent complication of knee dislocation with a reported frequency ranging from 14% to 40% [14]. The peroneal nerve is at risk because it is held tightly against the fibular head [11] and injury often is associated with proximal fibular fractures and posterolateral corner injuries [5,17]. Recovery of nerve injury is variable, reported as ranging from 31% to 75% [2,11,23,24,27].…”

Section: Introductionmentioning

confidence: 99%

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

Krych

Giuseffi

Kuzma

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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BackgroundPeroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury-with or without complete recovery-is a predictor of inferior patient-reported outcome scores. Questions/purposes The purposes of this study were to (1) report on motor and sensory recovery as well as patientreported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury. Methods Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models. Results Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial nerve palsy [83%]; p = 0.06). One patient with complete nerve palsy (13%) and 13 patients with partial nerve palsy (72%) regained antigravity extensor hallucis longus strength (p = 0.01). IKDC and Lysholm scores were similar between complete nerve palsy and partial nerve palsy groups. After controlling for confounding variables such as patient age, body mass index, injury interval to surgery, mechanism of injury, bicruciate injury, and popliteal artery injury status, there was no difference between patients with peroneal nerve injury and those without on Lysholm or IKDC scores.

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Drop Foot After Knee Dislocation: Evaluation and Treatment

Cited by 23 publications

References 57 publications

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Surgical treatment of multiligament knee injuries

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

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