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J Knee Surg 2012; 25(04): 327-334
DOI: 10.1055/s-0032-1322604
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Kaan Suleyman Irgit
1   Department of Orthopaedics, Geisinger Medical Center, Danville, Pennsylvania
,
Gerard Cush
1   Department of Orthopaedics, Geisinger Medical Center, Danville, Pennsylvania
› Author Affiliations
Further Information

Publication History

01 May 2012

20 May 2012

Publication Date:
30 July 2012 (online)

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Abstract

Although knee dislocations are relatively rare injuries; associated drop foot complication as a consequence of common peroneal nerve palsy (CPN) is substantially high. Even after successful ligament constructions; unresolved CPN palsy is a factor contributing to bad outcome after knee dislocations. CPN palsy is seen more after open dislocations, rotatory dislocations, and especially in patients with posterolateral corner injuries. CPN palsy can readily be diagnosed clinically, although high index of suspicion is needed. Surgical exploration in the acute setting is still debatable. Conservative management can be appropriate in early phase of treatment, however surgery is the choice of treatment for persistent nerve damage. Neurolysis, primary nerve repair, nerve grafting, and posterior tibialis tendon transfer are all reasonable choices for surgical treatment. Late surgery results have an exceedingly low success. Tibialis posterior tendon transfer is indicated primarily in the setting of a drop foot and a steppage gait. Tibialis posterior tendon transfer procedures have had acceptable success in allowing patients to return to ambulation without assistive device.

Keywords

peroneal nerve palsy - drop foot - posterior tibial tendon - knee dislocation - tendon transfer
 

  • References

  • 1 Monahan TJ. Treatment of nerve injuries in the multiple-ligament-injured knee. Oper Tech Sports Med 2003; 11: 208-217
    CrossrefPubMedGoogle Scholar
  • 2 Goitz RJ, Tomaino MM. Management of peroneal nerve injuries associated with knee dislocations. Am J Orthop 2003; 32 (1) 14-16
    PubMedGoogle Scholar
  • 3 Wright DG, Covey DC, Born CT, Sadasivan KK. Open dislocation of the knee. J Orthop Trauma 1995; 9 (2) 135-140
    CrossrefPubMedGoogle Scholar
  • 4 Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am 1963; 45: 889-904
    CrossrefPubMedGoogle Scholar
  • 5 Taylor AR, Arden GP, Rainey HA. Traumatic dislocation of the knee. A report of forty-three cases with special reference to conservative treatment. J Bone Joint Surg Br 1972; 54 (1) 96-102
    PubMedGoogle Scholar
  • 6 Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 2002; 30 (5) 718-727
    PubMedGoogle Scholar
  • 7 Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A (2) 262-273
    PubMedGoogle Scholar
  • 8 Ríos A, Villa A, Fahandezh H, de José C, Vaquero J. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma 2003; 55 (3) 489-494
    CrossrefPubMedGoogle Scholar
  • 9 Thomsen PB, Rud B, Jensen UH. Stability and motion after traumatic dislocation of the knee. Acta Orthop Scand 1984; 55 (3) 278-283
    PubMedGoogle Scholar
  • 10 Liow RY, McNicholas MJ, Keating JF, Nutton RW. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 2003; 85 (6) 845-851
    PubMedGoogle Scholar
  • 11 Wong CH, Tan JL, Chang HC, Khin LW, Low CO. Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc 2004; 12 (6) 540-544
    CrossrefPubMedGoogle Scholar
  • 12 Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma 2007; 21 (2) 92-96
    CrossrefPubMedGoogle Scholar
  • 13 LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med 1997; 25 (4) 433-438
    CrossrefPubMedGoogle Scholar
  • 14 Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 2003; 17 (3) 198-202
    CrossrefPubMedGoogle Scholar
  • 15 Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008; 21 (4) 261-268
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985; 198 (198) 94-101
    PubMedGoogle Scholar
  • 17 Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64 (4) 536-541
    CrossrefPubMedGoogle Scholar
  • 18 Stewart JD. Foot drop: where, why and what to do?. Pract Neurol 2008; 8 (3) 158-169
    CrossrefPubMedGoogle Scholar
  • 19 Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma 2002; 16 (5) 330-339
    CrossrefPubMedGoogle Scholar
  • 20 Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol 2009; 192 (1) 101-106
    CrossrefPubMedGoogle Scholar
  • 21 Bottomley N, Williams A, Birch R, Noorani A, Lewis A, Lavelle J. Displacement of the common peroneal nerve in posterolateral corner injuries of the knee. J Bone Joint Surg Br 2005; 87 (9) 1225-1226
    CrossrefPubMedGoogle Scholar
  • 22 Yu JS, Goodwin D, Salonen D , et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 1995; 164 (1) 135-139
    CrossrefPubMedGoogle Scholar
  • 23 Shields L, Mital M, Cave EF. Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 1969; 9 (3) 192-215
    CrossrefPubMedGoogle Scholar
  • 24 Gosk J, Rutowski R, Rabczyński J. The lower extremity nerve injuries - own experience in surgical treatment. Folia Neuropathol 2005; 43 (3) 148-152
    PubMedGoogle Scholar
  • 25 Berry H, Richardson PM. Common peroneal nerve palsy: a clinical and electrophysiological review. J Neurol Neurosurg Psychiatry 1976; 39 (12) 1162-1171
    CrossrefPubMedGoogle Scholar
  • 26 Baima J, Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med 2008; 1 (2) 147-153
    CrossrefPubMedGoogle Scholar
  • 27 Haftek J. Stretch injury of peripheral nerve. Acute effects of stretching on rabbit nerve. J Bone Joint Surg Br 1970; 52 (2) 354-365
    PubMedGoogle Scholar
  • 28 Sunderland SS, Williams HB. Nerve injuries and their repair: A critical appraisal. Plast Reconstr Surg 1992; 89: 1170
    CrossrefPubMedGoogle Scholar
  • 29 Seddon HJ. Peripheral nerve injuries in Great Britain during World War II; a review. Arch Neurol Psychiatry 1950; 63 (1) 171-173
    PubMedGoogle Scholar
  • 30 Magee DJ. Principles and concepts. In: Magee DJ, ed. Orthopedic physical assesment. Fifth Ed ed. St Louis Missouri: Saunders Elsevier; 2008
    Google Scholar
  • 31 Ghalambor N, Vangsness Jr CT. Traumatic dislocation of the knee: a review of the literature. Bull Hosp Jt Dis 1995; 54 (1) 19-24
    PubMedGoogle Scholar
  • 32 Johnson ME, Foster L, DeLee JC. Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 2008; 36 (12) 2448-2462
    CrossrefPubMedGoogle Scholar
  • 33 Trappeniers L, De Maeseneer M, Van Roy P, Chaskis C, Osteaux M. Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens. Eur Radiol 2003; 13 (7) 1722-1727
    CrossrefPubMedGoogle Scholar
  • 34 Gruber H, Peer S, Meirer R, Bodner G. Peroneal nerve palsy associated with knee luxation: evaluation by sonography—initial experiences. AJR Am J Roentgenol 2005; 185 (5) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 35 Bishop D, Moore A, Chandrashekar N. A new ankle foot orthosis for running. Prosthet Orthot Int 2009; 33 (3) 192-197
    CrossrefPubMedGoogle Scholar
  • 36 Ferris DP, Gordon KE, Sawicki GS, Peethambaran A. An improved powered ankle-foot orthosis using proportional myoelectric control. Gait Posture 2006; 23 (4) 425-428
    CrossrefPubMedGoogle Scholar
  • 37 Cush G, Irgit K. Drop foot after knee doslocation: evaulation and treatment. Sports Med Arth Rev 2011; 19: 139-146
    PubMedGoogle Scholar
  • 38 Sorell DA, Hinterbuchner C, Green RF, Kalisky Z. Traumatic common peroneal nerve palsy: a retrospective study. Arch Phys Med Rehabil 1976; 57 (8) 361-365
    PubMedGoogle Scholar
  • 39 Platt HLM. Traction lesions of the external popliteal nerve. Lancet 1940; 236: 612-614
    CrossrefPubMedGoogle Scholar
  • 40 Kim DH, Murovic JA, Tiel RL, Kline DG. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 2004; 54 (6) 1421-1428 , discussion 1428–1429
    CrossrefPubMedGoogle Scholar
  • 41 Hayes Jr DW, Mandracchia VJ, Webb GE. Nerve injury associated with plantarflexion-inversion ankle sprains. Clin Podiatr Med Surg 2000; 17 (2) 361-369 , vi–vii
    PubMedGoogle Scholar
  • 42 Kretschmer T, Antoniadis G, Braun V, Rath SA, Richter HP. Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg 2001; 94 (6) 905-912
    CrossrefPubMedGoogle Scholar
  • 43 Mont MA, Dellon AL, Chen F, Hungerford MW, Krackow KA, Hungerford DS. The operative treatment of peroneal nerve palsy. J Bone Joint Surg Am 1996; 78 (6) 863-869
    CrossrefPubMedGoogle Scholar
  • 44 Seidel JA, Koenig R, Antoniadis G, Richter HP, Kretschmer T. Surgical treatment of traumatic peroneal nerve lesions. Neurosurgery 2008; 62 (3) 664-673 , discussion 664–673
    CrossrefPubMedGoogle Scholar
  • 45 Wiesseman GJ. Tendon transfers for peripheral nerve injuries of the lower extremity. Orthop Clin North Am 1981; 12 (2) 459-467
    PubMedGoogle Scholar
  • 46 Garozzo D, Ferraresi S, Buffatti P. Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases. J Neurosurg Sci 2004; 48 (3) 105-112 , discussion 112
    PubMedGoogle Scholar
  • 47 Wood MB. Peroneal nerve repair. Surgical results. Clin Orthop Relat Res 1991; 267 (267) 206-210
    PubMedGoogle Scholar
  • 48 Mayer L. The physiological method of tendon transplantation in the treatment of paralytic drop-foot. J Bone Joint Surg Am 1937; 19: 389-394
    PubMedGoogle Scholar
  • 49 Watkins MB, Jones JB, Ryder Jr CT, Brown Jr TH. Transplantation of the posterior tibial tendon. J Bone Joint Surg Am 1954; 36-A (6) 1181-1189
    PubMedGoogle Scholar
  • 50 Carayon A, Bourrel P, Bourges M, Touzé M. Dual transfer of the posterior tibial and flexor digitorum longus tendons for drop foot. Report of thirty-one cases. J Bone Joint Surg Am 1967; 49 (1) 144-148
    PubMedGoogle Scholar
  • 51 Rodriguez RP. The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle 1992; 13 (2) 63-69
    CrossrefPubMedGoogle Scholar
  • 52 Richardson DR, Gause LN. The bridle procedure. Foot Ankle Clin 2011; 16 (3) 419-433 Review
    CrossrefPubMedGoogle Scholar
  • 53 Prahinski JR, McHale KA, Temple HT, Jackson JP. Bridle transfer for paresis of the anterior and lateral compartment musculature. Foot Ankle Int 1996; 17 (10) 615-619
    CrossrefPubMedGoogle Scholar
  • 54 Yeap JS, Birch R, Singh D. Long-term results of tibialis posterior tendon transfer for drop-foot. Int Orthop 2001; 25 (2) 114-118
    CrossrefPubMedGoogle Scholar
  • 55 Steinau HU, Tofaute A, Huellmann K , et al. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trauma Surg 2011; 131 (7) 903-910
    CrossrefPubMedGoogle Scholar
  • 56 Ferraresi S, Garozzo D, Buffatti P. Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer. Neurosurg Rev 2003; 26 (3) 175-179
    CrossrefPubMedGoogle Scholar
  • 57 Ozkan T, Tuncer S, Ozturk K, Aydin A, Ozkan S. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. J Reconstr Microsurg 2009; 25 (3) 157-164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Hall G. A review of drop-foot corrective surgery. Lepr Rev 1977; 48 (3) 184-192
    PubMedGoogle Scholar
  • 59 Andesen JG. Foot drop in leprosy and its surgical correction. Acta Orthop Scand 1963; 33: 151-171
    PubMedGoogle Scholar
  • 60 Richard BM. Interosseous transfer of tibialis posterior for common peroneal nerve palsy. J Bone Joint Surg Br 1989; 71 (5) 834-837
    PubMedGoogle Scholar
  • 61 Sedel L, Nizard RS. Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases. J Bone Joint Surg Br 1993; 75 (5) 772-774
    PubMedGoogle Scholar
  • 62 Aydin A, Ozkan T, Aydin HU , et al. The results of surgical repair of sciatic nerve injuries. Acta Orthop Traumatol Turc 2010; 44 (1) 48-53
    CrossrefPubMedGoogle Scholar