Successful Management of Foot Drop by Nerve Transfers to the Deep Peroneal Nerve

Nath, Rahul K.; Lyons, Andrew B; Paizi, Melia

doi:10.1055/s-0028-1082894

Cited by 83 publications

(89 citation statements)

References 12 publications

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“…The two patients with Grade M0 ankle dorsiflexion were an average age of 68 years (range, 66-70 years) with an average time to surgery of 7.5 months (range, 6-9 months). When comparing the patients in the present study with those in the study of Nath et al [12] study, with M3 or greater return of ankle dorsiflexion after nerve transfer, there was no difference in the average age of the patients or in the average time to surgery. Both studies showed a trend toward a more favorable outcome in younger patients and patients who underwent earlier surgery, although the number of patients in our study was too small for statistical analysis (Table 2).…”

Section: Discussionmentioning

confidence: 48%

“…Larger prospective clinical studies are needed to confirm the success of nerve transfers to obtain ankle dorsiflexion and the variables that could potentially predict favorable or unfavorable function after partial tibial nerve transfers to the anterior tibialis motor branch in the treatment of peroneal nerve injuries after high-energy trauma to the knee. Nath et al [12] reported on seven of nine patients who successfully regained BMRC Grade 4 or greater ankle dorsiflexion after tibial nerve transfers for deep peroneal nerve injuries. The remaining two of the nine patients obtained Grade M0 ankle dorsiflexion after the transfer.…”

Section: Discussionmentioning

confidence: 99%

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Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Giuffre

Bishop

Spinner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

106

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Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre-and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Giuffre

Bishop

Spinner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

106

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“…In the current study, we used antigravity muscle strength as a clinically meaningful recovery, and this likely resulted in higher percentages of patients defined as having recovered. In addition, patients in our series were treated with a variety of interventions, including neurolysis and nerve and tendon transfers, which have been previously demonstrated to improve recovery and function [9,16,21]. Despite surgical treatment, the peroneal nerve has a poor intrinsic ability for recovery, perhaps as a result of its variable and diminished intraneural blood supply [15].…”

Section: Discussionmentioning

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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“…77,132,138 Contrary to the most popular form of treatment (cyst resection) or even a more radical approach (nerve resection with or without nerve grafting or nerve transfer), 14,17,18,23,24,48,57,78,91,95,104,105,108,155,162,164,171 we recommend treating the articular branch connection and/or the joint. Even with isolated nerve transfer, 91 the articular branch remains connected to the neighboring joint, which would conceivably allow for cyst recurrence. We have shown that addressing the articular branch by ligating or disconnecting it near the joint or treating the articular pathology prevents intraneural cyst recurrence.…”

Section: Surgical Managementmentioning

confidence: 99%

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

Desy

Wang²,

Elshiekh

et al. 2016

JNS

113

134

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615 Literature review J Neurosurg 125:615-630, 2016I ntraneural ganglion cysts are benign mucinous lesions that are formed within peripheral nerves and typically lead to symptoms and signs of peripheral neuropathy. Their pathogenesis has been controversial. Different treatments have been recommended. Outcomes have been disappointing and the recurrence rate high and underreported.Over the past 15 years, our group has provided substantial evidence to support a unifying articular (synovial) theory as the etiology for all intraneural ganglion cysts. In 2003, the senior author (R.J.S.) demonstrated that the prototypical intraneural cysts of the common peroneal nerve are joint derived. Cyst formation originates in the superior tibiofibular joint (STFJ) and propagates toward abbreviatioNs EMG = electromyography; NCS = nerve conduction studies; STFJ = superior tibiofibular joint. obJective The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. methods In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. resuLts In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation o...

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Successful Management of Foot Drop by Nerve Transfers to the Deep Peroneal Nerve

Cited by 83 publications

References 12 publications

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

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

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

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