Abstract
Arthroscopically assisted anterior cruciate ligament reconstruction is regarded as a minimally invasive surgery with low morbidity but complications still occur. Reports of neurovascular injuries related to graft harvesting, tunnel placement, or graft fixation are limited. A rare case of peroneal nerve injury related to hardware used for graft fixation in the tibial in a 28-year-old female patient who underwent an anterior cruciate ligament reconstruction surgery using a patellar tendon graft (bone-tendon-bone graft) is presented. Post-operatively, the patient presented with clinical signs of peroneal nerve damage and a reduced range of motion of the knee. Plain radiographs of the knee showed the bicortical screw which used for tibial fixation of the graft, penetrating the fibula and projecting beyond the lateral cortex of the fibular neck. The patient was treated with removal of the hardware and the graft. Intensive physiotherapy resulted in gradual improvement and at 6 months after the second operation the patient regained full range of motion of the knee and almost full muscle strength performing her daily activities without any difficultly and she is at the moment unwilling to undergo further procedure.
Similar content being viewed by others
References
Bernard M, Grosthuses-Spork M, Georgoulis A, Hertel P (1994) Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc 2:14–18
Boyd KT, Myers PT (2003) Menicus preservation: rationale, repair techniques and results. Knee 10:1–11
Curran TA, Sekiya JK, Gibbs AE, Bonner KF (2006) Two techniques for anterior cruciate ligament tibial fixation with a bicortical screw: an in vitro study of neurovascular risk. Am J Orthop 35:261–264
Drosos GI, Stavropoulos NI, Kazakos KI (2007) Peroneal nerve damage by oblique proximal locking screw in tibial fracture nailing: a new emerging complication? Arch Orthop Trauma Surg 127:449–451
Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM (2000) Noncontact ACL injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150
Hall PM, Ryzewitz M, Walsh JP, Sherman HO (2009) Risk of iatrogenic injury to the peroneal nerve during posterolateral femoral tunnel placement in double–bundle ACL reconstruction. Am J Sports Med 37:109–113
Hems TE, Jones BG (2005) Peroneal nerve damage associated with the proximal locking screws of the AIM tibial nail. Injury 36:651–654
Janssen RPA, Scheltinga MRM, Sala HAGM (2004) Pseudoaneurysm of the popliteal artery after ACL reconstruction with bicortical tibial screw fixation. Arthroscopy 20:5–7
Johnson DS, Sharma DP, Bangash IH (1999) Common peroneal nerve palsy following knee arthroscopy. Arthroscopy 15:773–774
Krivić A, Stanec S, Zic R, Budi S, Milanović R, Stanec Z (2003) Lesion of the common peroneal nerve during arthroscopy. Arthroscopy 19:1015–1018
Magen HE, Howell SM, Hull ML (1999) Structural properties of six fixation methods for ACL soft tissue grafts. Am J Sports Med 1:19–23
Miller DB (1988) Arthroscopic meniscus repair. Am J Sports Med 16:315–320
Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2006) Injuries to the infrapatellar branch (es) of the saphenous nerve in ACL reconstruction with four–strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793
Peicha G, Pascher A, Schwarzl F, Pierer G, Fellinger M, Passler JM (1998) Transection of the peroneal nerve complicating knee arthroscopy: case report and cadaveric study. Arthroscopy 14:221–223
Phelan DT, Cohen AB, Fithian DC (2006) Complications of ACL reconstruction. Instr Course Lect 55:465–474
Post WR, King SS (2001) Neurovascular risk of bicortical tibial drilling for screw and spiked washer fixation of soft tissue ACL graft. Arthroscopy 17:244–247
Rodeo SA, Sobel M, Weiland AJ (1993) Deep peroneal nerve injury as a result of arthroscopic meniscectomy. A case report and review of the literature. J Bone Joint Surg (Am) 75:1221–1224
Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963
Sekiya JK, Ong BC, Bradley JP (2003) Complications in ACL surgery. Orthop Clin North Am 34:99–105
Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4:215–221
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Papoutsidakis, A., Drosos, G.I., Koukou, O.I. et al. Peroneal nerve damage by bicortical tibial screw in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18, 794–796 (2010). https://doi.org/10.1007/s00167-009-0980-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-009-0980-0