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Surgical management of peroneal nerve injuries

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Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Traumatic peroneal nerve injuries are typically associated with high-energy injuries. The aim of this study was to evaluate the demographics and outcomes following surgical management of peroneal nerve injuries.

Methods

Patients evaluated at a single institution with peroneal nerve injuries between 2001 and 2022 were retrospectively reviewed. Mechanism of injury, time to surgery, pre- and postoperative examinations, and operative reports were recorded. Satisfactory outcome, defined as the ability to achieve anti-gravity dorsiflexion strength or stronger following surgery, was compared between nerve grafting and nerve transfers in patients with at least 9 months of postoperative follow-up.

Results

Thirty-seven patients had follow-up greater than 9 months after surgery, with an average follow-up of 3.8 years. Surgeries included neurolysis (n=5), direct repair (n=2), tibial motor nerve fascicle transfer to the anterior tibialis motor branch (n=18), or interposition nerve grafting using sural nerve autograft (n=12). At last follow-up, 59.5% (n=22) of patients had anti-gravity strength or stronger dorsiflexion. Nineteen (51.4%) patients used an ankle-foot orthosis during all or some activities. In patients that underwent nerve grafting only across the peroneal nerve defect, 44.4% (n=4) were able to achieve anti-gravity strength or stronger dorsiflexion. In patients that had a tibial nerve fascicle transfer to the tibialis anterior motor branch of the peroneal nerve, 42.9% (n=6) were able to achieve anti-gravity strength or stronger dorsiflexion at last follow-up. There was no statistical difference between nerve transfers and nerve grafting in postoperative dorsiflexion strength (p = 0.51).

Conclusion

Peroneal nerve injuries frequently occur in the setting of knee dislocations and similar high-energy injuries. Nerve surgery is not universally successful in restoration of ankle dorsiflexion, with one-third of patients requiring an ankle-foot orthosis at mid-term follow-up. Patients should be properly counseled on the treatment challenges and variable outcomes following peroneal nerve injuries.

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Abbreviations

AFO:

Ankle-foot orthosis

PTT:

Posterior tibial tendon

mBMRC:

Modified British Medical Research Council

BMI:

Body mass index

CPN:

Common peroneal nerve

y:

Years

n :

Number

SD:

Standard deviation

mm:

Millimeter

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA

    Courtney Carlson Strother, Lauren E. Dittman, Robert J. Spinner, Allen T. Bishop & Alexander Y. Shin

  2. Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA

    Robert J. Spinner

Authors
  1. Courtney Carlson Strother
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  2. Lauren E. Dittman
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  4. Allen T. Bishop
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  5. Alexander Y. Shin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Courtney Carlson Strother and Lauren E. Dittman. The first draft of the manuscript was written by Courtney Carlson Strother, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alexander Y. Shin.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Mayo Clinic and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was conducted retrospectively from data obtained for clinical purpose. We consulted with the IRB of Mayo Clinic who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of Mayo Clinic.

Conflict of interest

CCS, LED, and ATB certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Author AYS receives royalties from Mayo Medical Ventures and TriMed and is on the editorial or governing board of Techniques in Hand and Upper Extremity Surgery. RJS receives royalties from Johnson & Johnson, Mayo Medical Ventures, and Saunders/Mosby-Elsevier and is part of the editorial or governing board of Clinical Anatomy, J Surgical Orthopedic Advances, Mayo Clinic Proceedings, Neurosurgery, and World Neurosurgery.

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Carlson Strother, C., Dittman, L.E., Spinner, R.J. et al. Surgical management of peroneal nerve injuries. Acta Neurochir 165, 2573–2580 (2023). https://doi.org/10.1007/s00701-023-05727-y

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