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Tendon Transfers for Peroneal Nerve Injuries in the Multiple-Ligament-Injured Knee

  • Shannon F. AlejandroEmail author
  • Patrick J. Maloney
  • Gerard J. Cush
Chapter

Abstract

Although knee dislocations are relatively rare, serious complications make treatment difficult. Common peroneal nerve (CPN) palsy is a debilitating complication with an incidence reported as high as 50%. Even after successful ligament reconstruction or repair, unresolved CPN palsy is a major factor contributing to poor outcomes. CPN palsy is more common with open dislocations, rotatory dislocations, and in patients with posterolateral corner injuries. CPN palsy can be readily diagnosed clinically, although a high index of suspicion is needed. Conservative management can be appropriate in the early phase of treatment, however for persistent nerve damage, surgery is the treatment of choice because it results in better functional outcomes. The benefit of surgical exploration in the acute setting is controversial. Neurolysis, primary nerve repair, nerve grafting, and posterior tibialis tendon transfer have all been utilized as surgical options. Because late surgical treatment of CPN typically results in poor prognosis, prompt diagnosis, and close follow-up are of paramount importance.

Keywords

Peroneal nerve Drop foot Posterior tibial tendon Knee dislocation Nerve graft Neuropraxia Axonotmesis Neurotmesis Neurolysis Silfverskiold test Electromyography Nerve conduction velocity Nerve action potential Ankle foot orthosis 

Abbreviations

CPN

Common Peroneal Nerve

PCL

Posterior cruciate ligament

PLC

Posterolateral corner

MRC

Medical Research Council

EMG

Electromyography

NCV

Nerve conduction velocity

NAP

Nerve action potential

MRI

Magnetic resonance imaging

AFO

Ankle foot orthosis

PTT

Posterior tibial tendon

FDL

Flexor digitorum longus

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shannon F. Alejandro
    • 1
    Email author
  • Patrick J. Maloney
    • 2
  • Gerard J. Cush
    • 3
  1. 1.Orthopaedic SurgeryGeisinger Medical CenterDanvilleUSA
  2. 2.Orthopaedic SurgeryThe Orthopedic Specialty Hospital at Mercy Medical CenterBaltimoreUSA
  3. 3.Geisinger Musculoskeletal Institute, Foot and Ankle Surgery, Orthopaedic SurgeryGeisinger Medical CenterDanvilleUSA

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