The blood supply of the common peroneal nerve in the popliteal fossa

Kadiyala, R. Kumar; Ramírez, Ana Francisca; Taylor, Aubrey E.; Saltzman, Charles L.; Cassell, Martin D.

doi:10.1302/0301-620x.87b3.15694

Cited by 51 publications

(34 citation statements)

References 26 publications

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“…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]. Previous studies have demonstrated that most peroneal nerve injuries occur in the setting of posterolateral corner injuries as a result of poor tolerance of the nerve to accommodate stretch with changes in limb position during trauma [22,25].…”

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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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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“…After the regression and involution of the axial artery, the accompanying artery of the sciatic nerve remains in adults, proximal to the tendinous opening of the adductor magnus muscle where during the embryological period the axial artery anastomoses with the developing femoral artery, and continues inferiorly as the popliteal artery [Kadiyala et al, 2005]. In all cases the accompanying artery of the sciatic nerve is detected as rudimentary blood vessel.…”

Section: Discussionmentioning

confidence: 99%

“…A recent opinion is that ischemia of the nerve as a result of thrombosis or embolism of the blood vessels has an important role in the postoperative paralysis of the nerve. For example, paralysis of the common peroneal nerve occurred very often after intra-aortic dilatation, iliac endarterectomy, aortoiliac bypass or femoral arteriography [Kadiyala et al, 2005]. Taking into the consideration that peripheral nerves get segmental vascularization from the neighboring muscular and cutaneous branches or arterial main trunks, the question that arises is: are all nerves or all segments of the nerve sufficiently supplied and are collateral anastomoses sufficiently developed to prevent ischemia of the nerves?…”

Section: Discussionmentioning

confidence: 99%

“…Taking into the consideration that peripheral nerves get segmental vascularization from the neighboring muscular and cutaneous branches or arterial main trunks, the question that arises is: are all nerves or all segments of the nerve sufficiently supplied and are collateral anastomoses sufficiently developed to prevent ischemia of the nerves? Kadiyala et al [2005], during their research of the blood supply of the common peroneal nerve in the popliteal fossa, concluded that the supply of the proximal part of the nerve originated in two thirds of the cases from the direct branch of the main trunk of the popliteal artery, but the long part of the nerve, which travels along the neck of the fibula, was insufficiently supplied by few intraneural blood vessels with a small caliber. This observation indicates that this segment of the nerve shows a predisposition for the different pathological and traumatic insults.…”

Section: Discussionmentioning

confidence: 99%

“…It can be assumed that different embryological origins of the nutrient arteries of the sciatic nerve can influence the arrangement, density and caliber of the intraneural vascular network. Kadiyala et al [2005] cite different embryological origins of the proximal and distal parts of the common fibular nerve and particularly insufficient blood supply of the part of the nerve which travels along the fibular neck. Although the largest part of the sciatic nerve is supplied by the branches of the femoral artery, its atherosclerotic changes and the decrease in the caliber of its lumen may influence the blood flow through the intraneural vascular network of the sciatic nerve.…”

Section: Discussionmentioning

confidence: 99%

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Extraneural Arterial Blood Vessels of Human Fetal Sciatic Nerve

Ugrenović

Jovanović²,

Vasović³

et al. 2007

Cells Tissues Organs

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Nerves get segmental blood supply either from the neighboring muscular and cutaneous branches or from the regional main arterial trunks. The aim of our research was to detect, in the gluteal and posterior femoral region, the blood vessels which are involved in the blood supply of the human fetal sciatic nerve, as well as to establish their origin. Micro-dissection was performed on 48 fetal lower extremities which were previously fixed in 10% formalin. Micropaque solution (barium sulfate) was injected into their blood vessels. The fetal gestational age was established by measuring the crump-crown length and it ranged from the third to the ninth lunar month. The observed nutritional arteries of the human sciatic nerve originated from the inferior gluteal artery, medial circumflex femoral artery, perforating branches, and popliteal artery. The anastomotic arterial chain of the human sciatic nerve was observed in all cases. In 75% of the cases it was composed of the branches of the inferior gluteal artery, the medial circumflex femoral artery and the first two perforating arteries. The nutrient branch of the third perforating branch was less frequently (in 14.5% of the cases) part of this anastomotic arterial chain.

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Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

Deeg

Mündel

Loizides

et al. 2023

Australas J Ultrason Med

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ObjectivesChanges in the microvascular environment are considered crucial in the pathogenesis of compression neuropathies. Several studies have demonstrated elevated intraneural vascularity in severe neuropathy compared with healthy subjects, where intraneural vascularity is considered predominantly undetectable. The aim of this study was to assess and quantify intraneural vasculature by superb microvascular imaging (SMI) in healthy volunteers in the median, ulnar and common peroneal nerve.MethodsIntraneural vascularity was quantified in 26 healthy volunteers (312 segments overall) by SMI sonography using a 22‐MHz linear transducer. Individual nerve segment vascularity was compared with the mean vascularity using one‐way ANOVA and Kruskal–Wallis tests, respectively. Vendor‐provided quantification and manual vessel count were compared by linear regression analysis.ResultsIntraneural vascularity was detectable in all nerve segments (100.0%). Vessel density was highest in the median nerve at the wrist (1.54 ± 0.44/mm2, P < 0.0001) and lowest in the sulcal ulnar nerve (0.90 ± 0.34/mm2, P < 0.0001). Vendor‐provided automated quantification severely overestimated vascular content compared with manual quantification.ConclusionSuperb microvascular imaging can facilitate the visualisation of nerve vascularity and even detect local variations in vessel density. The pathophysiological implications for peripheral neuropathies, especially compression neuropathies, warrant further investigation, but the absence of visible intraneural vasculature as a negative finding in the diagnostic of compression neuropathies should be interpreted with caution, as the intraneural vascularity may lie beyond the 18 MHz resolution power of a transducer.

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The blood supply of the common peroneal nerve in the popliteal fossa

Cited by 51 publications

References 26 publications

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

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

Extraneural Arterial Blood Vessels of Human Fetal Sciatic Nerve

Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

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