Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 11, pp 1583–1586 | Cite as

Surgical treatment of peroneal nerve palsy after knee dislocation

  • Bruce A. Levy
  • Steven A. Giuseffi
  • Allen T. Bishop
  • Alexander Y. Shin
  • Diane L. Dahm
  • Michael J. Stuart



Numerous surgical techniques have been described for the treatment of peroneal nerve palsy after knee dislocation with less than optimal outcomes. The purpose of this article is to present a review of the literature including modern surgical treatment options for peroneal nerve palsy after knee dislocation.


Review of the current body of literature relevant to the topic was undertaken and summarized accordingly. Mechanism of injury, pathology and prognosis as well as current and novel treatment options are presented.


Neurolysis and nerve grafting results are dependant on nerve graft length, with documented recovery rates of only 44% for nerve grafts longer than 6 cm. Posterior tibial tendon transfer procedures have had reasonable success in allowing patients to return to ambulation without assistive devices; however, dorsiflexion strength on the affected side has been reported at only 30% that of the normal contralateral side, and return to activities more strenuous than walking has not been reported. Future concepts including partial nerve transfer of a motor branch of the tibial nerve to the peroneal nerve have been described, but no outcome data is currently available.


Peroneal nerve palsy after knee dislocation leads to significant functional impairment. Prior treatment strategies utilized for restoration of dorsiflexion and peroneal nerve function have yielded overall poor results. Newer surgical techniques are being developed and clinical trials are under way to evaluate their effectiveness.


Peroneal nerve palsy Knee dislocation Multiligament knee injury Nerve transfer 


  1. 1.
    Bodily KD, Spinner RJ, Bishop AT (2004) Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study. Clin Anat 17:201–205CrossRefPubMedGoogle Scholar
  2. 2.
    Borden PS, Johnson DL (2001) Initial assessment of the acute and chronic multiple ligament-injured knee. Sports Med Arthroscop Review 9:178–184CrossRefGoogle Scholar
  3. 3.
    Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S (2009) Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc 17:1013–1026CrossRefPubMedGoogle Scholar
  4. 4.
    Garozzo D, Ferraresi S, Buffatti P (2004) Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases. J Neurosurg Sci 48:105–112PubMedGoogle Scholar
  5. 5.
    Giuffre JL, Kakar S, Bishop AT, Spinner RJ, Shin AY (2010) Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am 35:678–688 (quiz 688)Google Scholar
  6. 6.
    Goitz RJ, Tomaino MM (2003) Management of peroneal nerve injuries associated with knee dislocations. Am J Orthop 32:14–16PubMedGoogle Scholar
  7. 7.
    Good L, Johnson RJ (1995) The dislocated knee. J Am Acad Orthop Surg 3:284–292PubMedGoogle Scholar
  8. 8.
    Hoover NW (1961) Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am 41:1099–2112PubMedGoogle Scholar
  9. 9.
    Hosseinzadeh HR, Eajazi A, Kazemi SM, Besheli LD, Yeganeh MH, Aydanloo A (2009) Sudden peroneal nerve palsy in a varus arthritic knee. Orthopedics 32:920–923CrossRefGoogle Scholar
  10. 10.
    Johnson ME, Foster L, DeLee JC (2008) Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 36:2448–2462CrossRefPubMedGoogle Scholar
  11. 11.
    Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 54:1421–1428CrossRefPubMedGoogle Scholar
  12. 12.
    King JJ 3rd, Cerynik DL, Blair JA, Harding SP, Tom JA (2009) Surgical outcomes after traumatic open knee dislocation. Knee Surg Sports Traumatol Arthrosc 17:1027–1032CrossRefPubMedGoogle Scholar
  13. 13.
    Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25:430–438CrossRefPubMedGoogle Scholar
  14. 14.
    Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ (2009) Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 17:197–206PubMedGoogle Scholar
  15. 15.
    Meyers MH, Harvey JP Jr (1971) Traumatic dislocation of the knee joint. A study of eighteen cases. J Bone Joint Surg Am 53:16–29PubMedGoogle Scholar
  16. 16.
    Monahan TJ (2003) Treatment of nerve injuries in the multiple-ligament-injured knee. Op Tech Sports MED 11:208–217CrossRefGoogle Scholar
  17. 17.
    Niall DM, Nutton RW, Keating JF (2005) Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br 87:664–667CrossRefPubMedGoogle Scholar
  18. 18.
    Plancher KD, Siliski J (2008) Long-term functional results and complications in patients with knee dislocations. J Knee Surg 21:261–268PubMedGoogle Scholar
  19. 19.
    Robertson A, Nutton RW, Keating JF (2006) Dislocation of the knee. J Bone Joint Surg Br 88:706–711CrossRefPubMedGoogle Scholar
  20. 20.
    Schenck RC, Stannard JP, Wascher DC (2006) Dislocations and fracture-dislocations of the knee. In: Bucholz RW, Heckman JD, Court-Brown CM, Koval KJ, Tornetta III P, Wirth MA (eds) Rockwood and Green’s fractures in adults, 6th edn. Lippincott Williams & Wilkins, Philadelphia, p 2031Google Scholar
  21. 21.
    Seddon HJ (1943) Three types of nerve injury. Brain 66:237–288CrossRefGoogle Scholar
  22. 22.
    Sedel L, Nizard RS (1993) Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases. J Bone Joint Surg Br 75:772–774PubMedGoogle Scholar
  23. 23.
    Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9:192–215CrossRefPubMedGoogle Scholar
  24. 24.
    Shin AY, Spinner RJ, Steinmann SP, Bishop AT (2005) Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg 13:382–396PubMedGoogle Scholar
  25. 25.
    Sisto DJ, Warren RF (1985) Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 198:94–101PubMedGoogle Scholar
  26. 26.
    Tomaino M, Day C, Papageorgiou C, Harner C, Fu FH (2000) Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment. Knee Surg Sports Traumatol Arthrosc 8:163–165CrossRefPubMedGoogle Scholar
  27. 27.
    Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G (2008) New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res 466:1454–1466CrossRefPubMedGoogle Scholar
  28. 28.
    Wilkinson MC, Birch R (1995) Repair of the common peroneal nerve. J Bone Joint Surg Br 77:501–503PubMedGoogle Scholar
  29. 29.
    Wood MB (1991) Peroneal nerve repair. Surgical results. Clin Orthop Relat Res 267:206–210PubMedGoogle Scholar
  30. 30.
    Yeap JS, Birch R, Singh D (2001) Long-term results of tibialis posterior tendon transfer for drop-foot. Int Orthop 25:114–118CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Bruce A. Levy
    • 1
  • Steven A. Giuseffi
    • 1
  • Allen T. Bishop
    • 1
  • Alexander Y. Shin
    • 1
  • Diane L. Dahm
    • 1
  • Michael J. Stuart
    • 1
  1. 1.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA

Personalised recommendations