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Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the distances using ultrasound between the superficial peroneal nerve (SPN) and sural nerve along the peroneus longus tendon (PLT) autograft harvest path at different ankle or knee positions in order to minimize risk of iatrogenic nerve injury during PLT autograft harvest.

Methods

Twenty-four fresh–frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft with a tendon stripper. Four specimens were utilized to validate correct identification of nerves under ultrasound. Sonographically guided perineural injections were performed at the start point and end point of the PLT harvest path using coloured latex, followed by dissection with gross inspection. Using ultrasound, the distance from the peroneus brevis muscle to the sural nerve at different ankle positions (20° dorsiflexion, neutral, and 20° plantarflexion) was measured, and the distance from the end of the tendon stripper to the SPN at different knee positions (full extension and 90° flexion) was also measured. Measurements were performed by two separate observers using ImageJ software.

Results

Cadaveric dissection showed the presence of latex around nerves in all four specimens. The average distance from the brevis muscle to the sural nerve increased significantly from dorsiflexion to plantarflexion. The shortest distance from the tenodesis site to the sural nerve was 5.8 ± 1.7 mm. There was no significant difference from the end of the tendon stripper to the SPN between full extension or 90° flexion of the knee.

Conclusion

When harvesting the PLT, it is recommended to place the ankle at plantarflexion. The knee at full extension or 90° flexion had no effect. Joint positions at the time of graft harvest should be monitored to reduce risks of iatrogenic nerve injury.

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Abbreviations

PLT:

Peroneus longus tendon

SPN:

Superficial peroneal nerve

PBM:

Peroneus brevis muscle

FE:

Full extension

ICC:

Intraclass correlation coefficient

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Acknowledgements

The authors appreciate Dr. Jiaoju Wang from the Mathematics and Statistics School of Central South University discussing the sample size calculation and power analysis. The corresponding author would also thank Dr. Freddie Fu, Dr. Patrick Smolinski and Monica Linde from University of Pittsburgh, I miss all of you.

Funding

The Education Reform Foundation of Central South University (No. 2021JY188), National Natural Science Foundation of China (No. 81802208), and Natural Science Foundation of Hunan Province (No. 2021JJ40922) fund this study.

Author information

Author notes

  1. Song Wu and Benjamin Rothrauff contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China

    Song Wu & Jinshen He

  2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Benjamin Rothrauff

  3. Department of Ultrasound, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China

    Jiale Li

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Contributions

SW, BR and JH wrote the original manuscript and collected all the data. JL participated in the ultrasound procedures. All the authors assisted in the collection of all data and made suggestions for the manuscript. SW, BR and JH participated in the conception and design of the original study. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jinshen He.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was approved by the third Xiangya Hospital of Central South University (No. 2021-S229) and the specimens were obtained from official tissue providers.

Informed consent

No informed consent was required for this study.

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Supplementary Information

Below is the link to the electronic supplementary material.

167_2022_7202_MOESM1_ESM.tif

Supplementary file1 Fig. 1 Original ultrasound figures to validate the sonographic technique. A) captured ultrasound figure with needles in the tendon (original figure without markers); B) captured ultrasound figure with needle around the sural nerve (original figure without markers); C) captured ultrasound figure with needle around the peroneal nerve (original figure without markers). (TIF 9720 KB)

167_2022_7202_MOESM2_ESM.tif

Supplementary file2 Fig. 2 Original ultrasound figures in different ankle positions. Probe was placed around the ankle. (TIF 13560 KB)

167_2022_7202_MOESM3_ESM.tif

Supplementary file3 Fig. 3 Original ultrasound figures in different knee positions. Probe was placed around the knee. (TIF 7884 KB)

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Wu, S., Rothrauff, B., Li, J. et al. Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions. Knee Surg Sports Traumatol Arthrosc 31, 2454–2460 (2023). https://doi.org/10.1007/s00167-022-07202-0

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