Clin Orthop Relat Res (2012)

470:774778
DOI 10.1007/s11999-011-1981-0
!"#OI$": CO"#%&' ()&& %I*+"&), $R*&R!
Ris- .a/tors 0or #eroneal )er1e In23r4 an5 Re/o1er4 in
(nee Dislo/ation
Christopher 6. #es-3n "D7 6as Chahal "D7
81i !. tein0el5 9/7 Daniel 9. :helan "D
#3;lishe5 online: < +3=3st 2011
,he +sso/iation o0 9one an5 6oint 3r=eons1
2011
+;stra/t
9a/-=ro3n5 +/3te -nee 5islo/ation is
rare ;3t has a hi=h rate o0 asso/iate5
ne3ro1as/3lar in23ries an5 potentiall4
li>;-threatenin= /o>pli/ations. ,hese
in/l35e the s3;-stantial >or;i5it4
asso/iate5 ?ith peroneal ner1e in23r4:
ne3ropathi/ pain7 5e/rease5 >o;ilit47
an5 /onsi5era;l4 re53/e5 03n/tion7
?hi/h not onl4 i>pairs patient 03n/tion
;3t /o>pli/ates treat>ent.
@3estions/p3rposes :e there0ore
i5enti0ie5 an5 A3anti-0ie5 the ris-s
asso/iate5 ?ith spe/i0i/ 0a/tors 0or
peroneal ner1e in23r4 an5 re/o1er4 in
patients ?ith -nee 5islo/ations.
#atients an5 "etho5s :e
retrospe/ti1el4 re1ie?e5 the /harts o0
2< patients7 0ro> a>on= a /ohort o0 all
91 -nee 5islo/ations7 ?ith a peroneal
ner1e pals4 o1er a B-4ear perio5. :e
then 3se5 3ni1aria;le an5 >3lti1aria;le
statis-ti/s to i5enti04 ris- 0a/tors
pre5i/tin= peroneal ner1e in23r4 an5
re/o1er4.
Res3lts *en5er (o55s ratio7 B.47)7 ;o54
>ass in5eC (o55s ratio7 1.14)7 an5
0i;3lar hea5 0ra/t3re (o55s ratio7 4.77)
?ere asso/iate5 ?ith peroneal ner1e
in23r4. Onl4 4o3n=er a=e ?as asso/iate5
?ith peroneal ner1e re/o1er4.
&a/h a3thor /erti0ies that he or she has no
/o>>er/ial asso/iations (e=7 /ons3ltan/ies7
sto/- o?nership7 eA3it4
interest7 patent/li/ensin=
arran=e>ents7 et/) that
>i=ht pose a /on0li/t o0
interest in /onne/tion ?ith
the s3;>itte5 arti/le.
&a/h a3thor /erti0ies that his
or her instit3tion appro1e5
the h3>an proto/ol 0or this
in1esti=ation7 that all
in1esti=ations ?ere
/on53/te5 in /on0or>it4
?ith ethi/al prin/iples o0
resear/h7 an5 that in0or>e5
/onsent 0or parti/ipation in
the st354 ?as o;taine5.
C. 6. #es-3n7 6.
Chahal7 8. !.
tein0el57 D. 9.
:helan (&)
Depart>ent o0
Orthopae5i/
3r=er47 $ni1ersit4
o0 ,oronto7 t
"i/haelDs Eospital7
BB @3een treet &7
3ite 8007 ,oronto7
O) "BC 1R<7
Cana5a
e->ail:
5;F?helanGhot>ail./o>H
?helan5Gs>h.toronto.on./a
Con/l3sions (no?le5=e
o0 the ris- 0a/tors 0or
peroneal ner1e in23r4
an5 the pre5i/tors o0
re/o1er4 in -nee 5islo-
/ation allo?s the
treatin= s3r=eon to ha1e
a ;etter 3n5erstan5in=
o0 the nat3re o0 the
ne3rolo=i/ in23r4 an5
>o5i04 >ana=e>ent
;ase5 on the anti/ipate5
ret3rn o0 ner1e 03n/tion.
%e1el o0 &1i5en/e
%e1el II7 pro=nosti/
st354. ee *3i5e-lines
0or +3thors 0or a
/o>plete 5es/ription o0
le1els o0 e1i5en/e.
Intro53/tion
+/3te -nee 5islo/ation
is rare7 altho3=h the
in/i5en/e is li-el4
=reater than the reporte5
0.02I o0
>3s/3los-eletal tra3>a
;e/a3se o0 an 3n-no?n
n3>;er o0 spontaneo3s
re53/tions shortl4 a0ter
in23r47 there;4
in/reasin= the rate o0
>isse5 5ia=noses.
9e/a3se o0 the lo/al
anato>4 an5
>e/hanis>s o0 in23r47 there is a hi=h
rate o0 asso/iate5 ne3ro1as/3lar in23ries
an5 potentiall4 li>;-threatenin=
/o>pli/ations J < 7 17 7 19 7 29 K.
,he in/i5en/e o0 /on/o>itant
ne3rolo=i/ in23r4 ?ith -nee 5islo/ation
is esti>ate5 to ;e 0ro> 10I to 40I
?ith a ?i5e 5is/repan/4 ;et?een
reporte5 series J 2 7 10 7 18 7 20 7 24 7
2<7 27 K. ,he >ost 0reA3entl4 in23re5
ner1e is the /o>>on peroneal ner1e.
i>ilar to the anato>4
o0 the popliteal arter47
the /o>>on peroneal
ner1e is /onstraine5
proCi>all4 at the 0i;3lar
ne/- an5 5istall4 at the
inter->3s/3lar sept3>
;4 0i;ro3s ar/hes that
li>it its a;ilit4 to
a//o>>o5ate /han=es
in li>; position 53rin=
tra3>a J 1 7 2L K. In
a55ition7 ?hen
/o>pare5 ?ith other
peripheral ner1es7 the
peroneal ner1e >a4 ;e
inherentl4 pre5ispose5
to ne3ropraCi/ in23r4
53e to its in/onsistent
;loo5 s3ppl4 an5 la/-
o0 intrane3ral 1essels in
the se=>ent
s3rro3n5in= the 0i;3lar
ne/- J 11 K.
123
Mol3>e 4707 )3>;er L7 "ar/h 2012 #eroneal )er1e In23r4 in (nee Dislo/ation 77B
,he >or;i5it4 asso/iate5 ?ith posttra3>ati/ peroneal
ner1e pals4 is s3;stantial. .3n/tion7 ne3ropathi/ pain7 an5
o1erall A3alit4 o0 li0e are all ne=ati1el4 a00e/te5 ;4 pero-neal
ner1e in23r4 J L 7 4 K. + patient ?ith 0oot 5rop ?al-s ?ith a
steppa=e =ait an5 >a4 reA3ire the 3se o0 an an-le-0oot
orthosis. In the settin= o0 -nee 5islo/ation7 peroneal ner1e
in23r4 has ?i5esprea5 reper/3ssions. ,he a;ilit4 to ha1e a
sta;le7 ?ell-03n/tionin=7 an5 pain-0ree -nee is stron=l4
in0l3en/e5 ;4 the ne3rolo=i/ 03n/tion o0 the 0oot an5 an-le.
#eroneal ner1e pals4 is o0ten a 0r3stratin= an5 5e;ilitatin=
pro;le> 0or patients an5 has i>portant i>pli/ations 0or the
ti>in= o0 s3r=i/al re/onstr3/tion an5 3lti>ate -nee 03n/tion.
e1eral series J 2 7 10 7 18 7 22 7 2< K 5es/ri;e the
in/i5en/e o0 peroneal ner1e in23r4 asso/iate5 ?ith -nee
5islo/ation7 ;3t these st35ies 5i5 not i5enti04 or A3anti04 the
ris- 0a/tors 0or peroneal ner1e in23r4 an5 re/o1er4. +=e7
=en5er7 ;o54 >ass in5eC (9"I)7 >e/hanis> o0 in23r47 an5
pattern o0 li=a>ento3s in23r4 are all pla3si;le /ontri;3tors to
the ris- o0 in23r4. ,hese 0a/tors >a4 also in0l3en/e the a;ilit4
o0 the peroneal ner1e to spontaneo3sl4 re/o1er 0ro> in23r4.
Despite the 0a/t that these 1aria;les are lar=el4 non>o5i-
0ia;le7 an 3n5erstan5in= o0 these ris- 0a/tors >a4 ai5 the
treatin= orthopae5i/ s3r=eon in pre5i/tin= patients ?ho are
pre5ispose5 to peroneal ner1e in23r4. (no?le5=e o0 these
0a/tors >a4 ;e 3se03l ?hen a patient is 5i00i/3lt to eCa>ine
or 3nrelia;le an5 >a4 ;e 3tiliNe5 in a51isin= patients
re=ar5in= their potential 0or ne3rolo=i/ re/o1er4. "ore-o1er7
the li-elihoo5 o0 peroneal ner1e re/o1er4 >a4 alter the ti>e
/o3rse an5 spe/i0i/ pro/e53res in1ol1e5 in s3r=i-/al
>ana=e>ent.
:e there0ore (1) i5enti0ie5 an5 A3anti0ie5 spe/i0i/ ris-
0a/tors 0or peroneal ner1e in23r4 in a/3te -nee 5islo/ation
,a;le 1. 9aseline /hara/teristi/s an5 3ni1ariate anal4sis
an5 (2) i5enti0ie5 0a/tors
that in0l3en/e the re/o1er4
o0 peroneal ner1e in23ries
a0ter a -nee 5islo/ation.
#atients an5 "etho5s
+ sear/h o0 hospital an5
s3r=eon 5ata;ase re/or5s
i5enti-0ie5 all 91 patients
;et?een the a=es o0 1< an5
<0 4ears presentin= ?ith a
5ia=nosis o0 -nee
5islo/ation ;et?een 200B
an5 2010. :e eC/l35e5
patients ?ho 5ie5 shortl4
a0ter in23r4 or ha5 se1ere
hea5 in23r4 (three patients)
0ro> the anal4sis. ,here
?ere 72 >ale patients
(79I)H the a1era=e a=e ?as
LL.< 4ears (ran=e7 1<B7
4ears) an5 the a1era=e 9"I
?as 27.7 -=/>
2
(ran=e7
14.742.1 -=/>
2
). ,he
>e/hanis> o0 in23r4 ?as
hi=h ener=4 in 44 patients
(48I). .ra/t3re o0 the
0i;3lar hea5 ?as present in
19 patients (21I)7 an5 the
posterior /r3/iate li=a>ent
(#C%) ?as 5isr3pte5 in 7<
patients (84I). ,he >ost
/o>>on li=a>ento3s in23r4
pattern ?as (D III%7
a00e/tin= LL patients (L<I).
Mas/3lar in23r4 reA3irin=
s3r=i/al re/onstr3/tion ?as
present in 0i1e patients
(B.BI). O1erall7 74 patients
(81I) ?ere treate5 ?ith
li=a>ento3s re/on-str3/tion
(,a;le 1 ). #eroneal ner1e
in23r4 ?as 5e0ine5 as la/-
o0 sensation o1er the
5ors3> o0 the 0oot an5 0/B
>otor 03n/tion as =ra5e5 ;4
the "e5i/al Resear/h
Co3n/il /ri-teria J 1B K. O0
the 91 patients7 2< patients
(29I) ha5 peroneal ner1e
in23r4. In this /ohort o0
ner1e-in23re5 patients7 there
?ere 24 >ales (92I)H the
a1era=e a=e ?as L4.1 4ears
(ran=e7 1<B2 4ears) an5 the
a1era=e 9"I ?as L2.<
-=/>
2
(ran=e7 22.142.1
-=/>
2
). ,he >e/hanis> o0
in23r4 ?as hi=h ener=4 in 11
patients (42I). .ra/t3re o0
the 0i;3lar hea5 ?as present
in 10 patients (L9I)7 an5
the #C% ?as 5isr3pte5 in 2L
patients (89I). Mas/3lar
in23r4
Maria;le (nee 5islo/ation /ohort (n O 91)
+=e (4ears)P LL.<
9o54 >ass in5eC (-=/>
2
)P 27.7
*en5er (>ale) (n3>;er) 72
"e/hanis> o0 in23r4 (hi=h ener=4)
In23r4 /lassi0i/ation (/hen/-)
(D I
(D II
(D III%
(D III"
(D IM
(D M
.i;3lar hea5 0ra/t3re
#osterior /r3/iate li=a>ent in23r4 7< (8L.BI)
Mas/3lar in23r4 B (B.BI)
P Mal3es are eCpresse5 as >ean7 ?ith D in
parentheses.
123
77< #es-3n et al. Clini/al Orthopae5i/s an5 Relate5 Resear/h
1
reA3irin= s3r=i/al re/onstr3/tion ?as present in 0o3r patients
(1BI). ,he >ost /o>>on li=a>ento3s in23r4 pattern ?as
(D III%7 a00e/tin= 18 patients (<9I). + total o0 ei=ht patients
ha5 re/o1er4 o0 peroneal ner1e 03n/tion (L1I). ,he
>ini>3> 0ollo?3p ?as 12 >onths (>ean7 LL.2 >onthsH
ran=e7 12B8 >onths). )o patients ?ere lost to 0ollo?3p. )o
patients ?ere re/alle5 spe/i0i/all4 0or this st354H all 5ata
?ere o;taine5 0ro> >e5i/al re/or5s. :e ha5 prior
Instit3tional Resear/h &thi/s 9oar5 appro1al 0or the /hart
re1ie? 0or ea/h st354 s3;2e/t.
:e /reate5 a 5ata a;stra/tion 0or> to =ather in0or>ation
re=ar5in= patient a=e7 =en5er7 9"I7 atten5in= s3r=eon7
/o>>on peroneal ner1e in23r47 /o>>on peroneal ner1e
re/o1er47 >e/hanis> o0 in23r47 an5 operati1e treat>ent.
"e/hanis> o0 in23r4 ?as strati0ie5 into lo? ener=4 an5 hi=h
ener=4. :e /lassi0ie5 pattern o0 li=a>ento3s in23r4 a//or5in=
to the s4ste> 0or -nee 5islo/ations 5e1elope5 ;4 /hen/- J
2BK. #lain ra5io=raphs an5 "RI st35ies ?ere re1ie?e5 to
/on0ir> asso/iate5 0ra/t3res an5 li=a>ento3s pattern o0
in23r4.
:e >onitore5 re/o1er4 o0 the peroneal ner1e on a
>onthl4 ;asis ;4 /lini/al eCa>ination an5 &"* testin=.
&"* testin= ?as per0or>e5 ?hen there ?as la/- o0 /lin-i/al
i>pro1e>ent in peroneal 03n/tion at L >onths postin23r4. +
peroneal ner1e pals4 ?as /lassi0ie5 as QQre/o1ere5DD ?hen it
o;taine5 a s3;2e/ti1e ret3rn o0 li=ht to3/h sensation an5 a
"e5i/al Resear/h Co3n/il s/ore o0 B/B J 1B K. #atients ?ith
an asso/iate5 peroneal ner1e in23r4 ?ere treate5 ?ith
o;ser1ation (n O 4)7 ne3rol4sis (n O 21)7 or ner1e =ra0tin= (n
O 1). ,he in5i/ation 0or ne3rol4sis ?as presen/e o0 a
nonla/erate5 peroneal ner1e in23r4 ?ith /on/o>itant
re/onstr3/tion o0 the lateral/pos-terolateral str3/t3res o0 the
-nee. + sin=le ner1e =ra0tin= pro/e53re ?as per0or>e5 in the
settin= o0 an a/3te pero-neal ner1e la/eration. ,he ro3tine
3se o0 ner1e =ra0tin= ?as pre/l35e5 53e to the ;roa5 None o0
in23r4 an5 >e/hanis> (tra/tion) in >ost /ases. &i=hteen
patients ha5 nonresol1in= peroneal ner1e palsies7 o0 ?hi/h
se1en ?ere treate5 ?ith trans0er o0 the posterior ti;ialis
ten5on an5 siC reA3ire5 the 3se o0 an an-le-0oot orthosis. ,he
in5i/ation 0or ten5on trans0er ?as persistent peroneal ner1e
pals4 an5 patient 5issatis0a/tion ?ith 3se o0 an orthosis.
+0ter trans0er o0 the posterior ti;ial ten5on7 patients ha5
their an-le i>>o;iliNe5 0or < ?ee-s7 0ollo?e5 ;4 enroll-
>ent in a ph4siotherap4 pro=ra> 0o/3se5 on restoration o0
RO". :ei=ht;earin= ?as reintro53/e5 at 10 to 12 ?ee-s
postoperati1el4 as part o0 =ait retrainin=. + /on/o>itant
5e5i/ate5 ph4siotherap4 pro=ra> a5herin= to a >3ltili=a-
>ent -nee re/onstr3/tion proto/ol ?as 3se5 0or -nee
reha;ilitation J 1< K.
Data a/A3isition ?as re1ie?e5 an5 1eri0ie5 in5epen-
5entl4 an5 in 53pli/ate ;e0ore statisti/al anal4sis. "issin=
5ata /o>prise5 less than 10I o0 all 5ata an5 ?ere
/orre/te5 0or ;4 the 3se o0
>ean 1al3es. "eans7
ran=es7 an5 /on0i5en/e
inter1als ?ere /al/3late5 0or
/ontin3o3s 1ari-a;les (a=e7
9"I7 ti>e to 0ollo?3p) an5
/o>pare5 ;et?een the
peroneal ner1e pals4 an5
nonperoneal ner1e pals4
/ohorts 3sin= t35entDs t
test. :e /al/3late5
0reA3en/ies 0or /ate=ori/al
1aria;les (=en5er7
>e/hanis> o0 in23r47 in23r4
/lassi0i/ation7 0i;3lar hea5
0ra/t3re7 #C% in23r47 an5
1as/3lar in23r4) an5
/o>pare5 the> 3sin= /hi
sA3are or .isherDs eCa/t
tests. $sin= a si=ni0i/an/e
le1el o0 p R 0.0B 0or 0a/tors
in the 3ni1aria;le anal4ses7
?e i5enti0ie5 potential
1aria;les 0or a >3lti1aria;le
lo=isti/ re=ression >o5el to
i5enti04 >a2or ris- 0a/tors
0or peroneal ner1e in23r4.
,he pre5i/tor 1aria;les 0or
the >o5el ?ere a=e7 =en5er7
9"I7 >e/hanis> o0 in23r47
presen/e o0 an in23r4 to the
#C%7 an5 0ra/t3re o0 the
0i;3lar hea5. ,he o3t/o>e
1aria;le ?as the presen/e o0
a peroneal ner1e in23r4.
$ni1aria;le statisti/al
te/hniA3es ?ere 3se5 to
i5enti04 0a/tors asso/iate5
?ith peroneal ner1e
re/o1er4. ,he 1aria;les o0
interest ?ere a=e7 9"I7
>e/hanis> o0 in23r47 an5
0i;3lar hea5 0ra/t3re. :e
per0or>e5 statisti/al
anal4sis o0 5ata 3sin=
"ini,a;
1
1< ("ini,a;7 In/7
tate Colle=e7 #+) /o>p3ter
so0t?are.
Res3lts
$ni1aria;le anal4sis
/o>parin= patients ?ith an5
?itho3t peroneal ner1e
in23r4 sho?e5 the peroneal
in23r4 /ohort to ha1e a
hi=her (p O 0.020<) 9"I. In
a55ition7 there ?ere
5i00eren/es in presen/e o0
0i;3lar hea5 0ra/t3re (p O
0.009) an5 presen/e o0 a
1as/3lar in23r4 (p O 0.0LB).
,here ?ere no 5i00eren/es
0or a=e7 =en5er7 >e/hanis>
o0 in23r47 or presen/e o0
#C% 5isr3ption (,a;le 1 ).
"3lti1ariate re=ression
anal4sis re1eale5 =en5er (p
O 0.049H o55s ratio JORK7
B.47)7 9"I (p O 0.024H OR7
1.14)7 an5 0i;3lar hea5
0ra/t3re (p O 0.012H OR7
4.77) to ;e pre5i/ti1e o0
peroneal ner1e in23r4 in
-nee 5islo/ation (,a;le 2 ).
+=e7 >e/hanis> o0 in23r47
an5 #C% 5isr3ption 5i5 not.
,a;le 2. "3lti1ariate anal4sis
Maria;le
#eroneal ner1e
in23r4
p Mal3e O55s
9BI
/on0i5en/e
ratio inter1al
+=e (4ears) 0.<82 0.99 0.9B7 1.04
9o54 >ass in5eC 0.024 1.14 1.027 1.28
*en5er (>ale) 0.049 B.47 1.017 29.8
"e/hanis> o0 in23r4 0.880 0.92 0.LL7 2.B8
(hi=h ener=4)
.i;3lar hea5 0ra/t3re 0.012 4.77 1.407 1<.2
#osterior /r3/iate 0.14B L.2B 0.<77 1B.8
li=a>ent in23r4
123
Mol3>e 4707 )3>;er L7 "ar/h 2012 #eroneal )er1e In23r4 in (nee Dislo/ation 777
!o3n=er a=e (p R 0.001) ?as the sole 1aria;le asso/i-ate5
?ith peroneal ner1e re/o1er4.
Dis/3ssion
#eroneal ner1e in23r4 is an i>portant /o>pli/atin= 0a/tor in
the settin= o0 -nee 5islo/ation7 ha1in= 5eleterio3s e00e/ts on
03n/tion7 ne3ropathi/ pain7 an5 o1erall A3alit4 o0 li0e. ,he
a;ilit4 to i5enti04 patients ?ho are at in/rease5 ris- o0
peroneal ner1e in23r4 an5 persistent pals4 >a4 ai5 the
treatin= s3r=eon in pro1i5in= ti>el4 an5 appropriate s3r-=i/al
>ana=e>ent. :e there0ore 5eter>ine5 ris- 0a/tors 0or
peroneal ner1e in23r4 an5 pro=nosti/ 0a/tors 0or re/o1er4 in
-nee 5islo/ation.
,his retrospe/ti1e /ohort st354 has se1eral li>itations.
.irst7 >an4 o0 the patients ?ere re0erre5 to o3r tertiar4 /are
/enter 0ro> o3tsi5e instit3tions. ,his sele/tion ;ias >a4 ha1e
res3lte5 in a 5isproportionatel4 hi=her n3>;er o0
/o>pli/ate5 -nee 5islo/ations ?ith ne3rolo=i/ a;nor>ali-ties
in o3r /ohort. Eo?e1er7 the rate o0 peroneal ner1e in23r4 an5
re/o1er4 in o3r /ohort is /o>para;le to that 5es/ri;e5 in the
literat3re. e/on57 the patients in/l35e5 in the st354 ?ere not
ran5o>l4 allo/ate5 to a s3r=i/al treat->ent >etho5 ?ith
respe/t to the li=a>ento3s pattern o0 in23r4 or the presen/e o0
peroneal ner1e pals4. Rather7 an ar;itrar4 5e/ision ?as >a5e
;ase5 on s3r=eon pre0eren/e. One patient7 ?ith a /o>plete
la/eration o0 the peroneal ner1e7 ?as treate5 ?ith ner1e
=ra0tin= (?hi/h 0aile5)7 0o3r patients ?ere o;ser1e57 an5 the
re>ainin= 21 patients 3n5er?ent ne3rol4sis. ,he spe/i0i/
>etho5 3se5 0or treat->ent >a4 ha1e a00e/te5 ne3rolo=i/
re/o1er4H ho?e1er7 there is no 5e0initi1e e1i5en/e to s3pport
this. ,hir57 the relati1el4 s>all n3>;er o0 patients in o3r
st354 ?o3l5 in0l3en/e the po?er o0 the st354 an5 s3;2e/t the
anal4sis to ,4pe II errors. Eo?e1er7 -nee 5islo/ation is
relati1el4 3n/o>>on an5 o3r series is relati1el4 lar=e ?ith a
hi=h per/enta=e o0 0ollo?3p. O3r st354 pop3lation 5i5 ha1e
si>ilar ;aseline /hara/teristi/s as other st35ies J 2 7 10 7 18 7
207 22 7 2< 7 L0 K eCa>inin= peroneal ner1e pals4 asso/iate5
?ith -nee 5islo/ation (,a;le L ). In a55ition7 the in/i5en/e o0
ner1e in23r4 an5 ner1e re/o1er4 rate ?as /o>para;le. ,hese
st35ies 1ali5ate o3r 0in5in=s ?ith respe/t to patient
5e>o=raphi/s7 peroneal ner1e in23r4 rate7 an5 peroneal ner1e
re/o1er4.
:e 0o3n5 hi=her 9"I to pre5i/t peroneal ner1e in23r4 ?ith
-nee 5islo/ation. ,his 0in5in= /on0ir>s reports in the literat3re
5es/ri;in= 3ltra-lo?-ener=4 -nee 5islo/ations ?ith
ne3ro1as/3lar in23r4 in >or;i5l4 o;ese patients J 14 7 21 K. ,he
s3praph4siolo=i/ stress i>parte5 to the -nee an5 s3rro3n5in=
str3/t3res 53rin= in23r4 in o;ese patients li-el4 /ontri;3tes to
this 0in5in=. #eroneal ner1e in23r4 ?as also pre5i/te5 ;4 the
presen/e o0 a 0i;3lar hea5 0ra/t3re7 ?hi/h
,a;le L. In/i5en/e an5 re/o1er4
o0 peroneal ner1e pals4 in -nee
5islo/ation
t354 In/i5en/e
"e4ers et al. J 18 K 14/BL (2<I)
isto an5 :arren J 2< K 8/20 (40I)
:erier et al. J L0 K </L8 (1<I)
Earner et al. J 10 K 4/L1 (1LI)
)iall et al. J 20 K 14/BB (2BI)
9onne1ialle et al. J 2 K 12/<7 (18I)
#lan/her an5 ilis-i J 22 K 18/B0 (L<I)
#es-3n et al. 2</91 (29I)
is li-el4 a s3rro=ate >eas3re
0or 5isr3ption o0 the pos-
terolateral /orner o0 the
-nee. ,his 0in5in= /on0ir>s
that o0 a pre1io3s st354
reportin= a 100I rate o0
posterolateral /orner in23r4
in patients ?ith peroneal
ner1e pals4 a0ter -nee
5islo/ation J 20 K. ,he
inti>ate /onta/t ;et?een the
peroneal ner1e an5
posterolateral /orner o0 the
-nee >a-es ner1e in23r4 a
0reA3ent 0in5in= in -nee
5islo/ation. .i;3lar hea5
0ra/t3re is an easil4
i5enti0ie5 0a/tor that /an ;e
seen on plain ra5io=raphs
an5 >a4 ;e parti/3larl4
3se03l 0or pre5i/tin= the
li-elihoo5 o0 peroneal ner1e
in23r4 in o;t3n5e5 patients
or those ?ho are 3na;le to
/o>pl4 ?ith a /o>plete
ne3rolo=i/ eCa>ination.
,he rate o0 peroneal
ner1e re/o1er4 in o3r st354
?as L1I7 ?hi/h is
/o>para;le to that in the
literat3re. !o3n=er patient
a=e ?as a 0a1ora;le 0a/tor
0or peroneal ner1e re/o1er4.
,he a1era=e a=e o0 patients
?ho ha5 spontaneo3s
re/o1er4 o0 peroneal ner1e
03n/tion ?as 22.7 4ears
?ith onl4 one patient ol5er
than a=e L0 4ears. ,hese
0in5in=s are /onsistent ?ith
;asi/ s/ien/e an5 /lini/al
st35ies eCa>in-in=
peripheral ner1e re/o1er4
a0ter in23r4 J 12 7 1L K7
s3==estin= the eCtent o0
aConal re=eneration in
peripheral ner1e in23ries
5e/reases ?ith a=e. In
a55ition7 the te>poral rate
o0 peripheral ner1e re/o1er4
>a4 ;e i>paire5 ?ith
in/reasin= a=e J 28 K.
,he treat>ent o0
peroneal ner1e in23r4 in the
settin= o0 -nee 5islo/ation
re>ains /hallen=in= ?ith
in/onsistent 0in5in=s J B 7
7 9 K. ,he >or;i5it4
asso/iate5 ?ith peroneal
ner1e in23r4 ?ith a -nee
5islo/ation is /onsi5era;le.
In/rease5 pain an5 lo?er
03n/tion /o>pli/ate
postopera-ti1e re/o1er4 o0
the patient. + ;etter
3n5erstan5in= o0 the ris-
0a/tors 0or peroneal ner1e
in23r4 an5 the pre5i/tors o0
re/o1er4 >a4 allo? the
treatin= s3r=eon to i5enti04
at-ris- patients an5 to
pro=nosti/ate 0or re/o1er4
o0 ner1e 03n/tion in these
rare ;3t /hallen=in=
in23ries.
Re0eren/es
1. +i=ner .7 %on=ato 7
*ar5etto +7 Dei;l "7 .rits/h
E7 #iNa-(atNer E. +nato>i/
s3r1e4 o0 the /o>>on
0i;3lar ner1e an5
123
778 #es-3n et al. Clini/al Orthopae5i/s an5 Relate5 Resear/h
1
its ;ran/hin= pattern ?ith re=ar5 to the inter>3s/3lar septa o0 the
le=. Clin +nat. 2004H17:B0LB12.
2. 9onne1ialle #7 D3;rana .7 *ala3 97 %3sti= 7 9ar;ier O7 )e4ret #7
Rosset #7 ara=a=lia DH la o/ieSteS 0ran/Taise 5e /hir3r=ie orthope
S5iA3e et tra3>atolo=iA3e. Co>>on peroneal ner1e pals4
/o>pli/atin= -nee 5islo/ation an5 ;i/r3/iate li=a>ents tears.
Orthop ,ra3>atol 3r= Res. 2010H9<:<4<9.
L. Ciara>itaro #7 "on5elli "7 %o=3llo .7 *ri>al5i 7 9attiston 97 ar5 +7
/arinNsi C7 "i=liaretti *7 .a//ani *7 Co/ito DH Italian )et?or- 0or
,ra3>ati/ )e3ropathies. ,ra3>ati/ peripheral ner1e in23ries:
epi5e>iolo=i/al 0in5in=s7 ne3ropathi/ pain an5 A3alit4 o0 li0e in 1B8
patients. 6 #eripher )er1 4st. 2010H1B:120127.
4. 5e 9r3i2n I%7 *eertNen 6E7 Di2-stra #$. .3n/tional o3t/o>e a0ter
peroneal ner1e in23r4. Int 6 Reha;il Res. 2007HL0:LLLLL7.
B. .erraresi 7 *aroNNo D7 9300atti #. Co>>on peroneal ner1e
in23ries: res3lts ?ith one-sta=e ner1e repair an5 ten5on trans0er.
)e3ros3r= Re1. 200LH2<:17B179.
<. .rassi/a .67 i> .E7 taeheli 6:7 #airolero #C. Dislo/ation o0 the
-nee. Clin Orthop Relat Res. 1991H2<L:20020B.
7. *aroNNo D7 .erraresi 7 9300atti #. 3r=i/al treat>ent o0 /o>>on
peroneal ner1e in23ries: in5i/ations an5 res3lts: a series o0
<2 /ases. 6 )e3ros3r= /i. 2004H48:10B112.
8. *i3se00i +7 9ishop +,7 hin +!7 Dah> D%7 t3art "67 %e14 9+.
3r=i/al treat>ent o0 peroneal ner1e pals4 a0ter -nee 5is-lo/ation.
(nee 3r= ports ,ra3>atol +rthros/. 2010H18:1B8L 1B8<.
9. *oitN R67 ,o>aino "". "ana=e>ent o0 peroneal ner1e in23ries
asso/iate5 ?ith -nee 5islo/ations. +> 6 Orthop (9elle "ea5 )6).
200LHL2:141<.
10. Earner CD7 :altrip R%7 9ennett CE7 .ran/is (+7 Cole 97
Irr=an= 66. 3r=i/al >ana=e>ent o0 -nee 5islo/ations. 6 9one 6oint
3r= +>. 2004H8<:2<227L.
11.(a5i4ala R(7 Ra>ireN +7 ,a4lor +&7 altN>an C%7 Cassell "D.
,he ;loo5 s3ppl4 o0 the /o>>on peroneal ner1e in the popliteal
0ossa. 6 9one 6oint 3r= 9r. 200BH87:LL7L42.
12. (o1a/i/ $7 -etel2 67 9a2ro1i/S ... +=e-relate5 5i00eren/es in
the reinner1ation a0ter peripheral ner1e in23r4. Int Re1 )e3ro;iol.
2009H87:4<B482.
1L. (o1a/i/ $7 8ele ,7 "ars ,7 -etel2 67 9a2ro1i/S ... +=in=
i>pairs /ollateral spro3tin= o0 no/i/epti1e aCons in the rat.
)e3ro;iol +=in=. 2010HL1:LL9LB0.
14. "arin &%7 9i03l/o 7 .ast +. O;esit4. + ris- 0a/tor 0or -nee
5islo/ation. +> 6 #h4s "e5 Reha;il. 1990H<9:1L21L4.
1B. "e5i/al Resear/h
Co3n/il. +i5s to the
&Ca>ination o0 the
#eripheral )er1o3s 4ste>.
%on5on7 $(: Eer "a2est4Ds
tatio-ner4 O00i/eH 197<.
1<. "e51e/-4 "67 8aN3la-
9,7 Ee?ett ,&. +
>3lti5is/iplinar4 approa/h to
the e1al3ation7 re/onstr3/tion
an5 reha;ilitation o0 the >3lti-
li=a>ent in23re5 athlete.
ports "e5. 2007HL7:1<9187.
17. "e4ers "E7 Ear1e4
6# 6r. ,ra3>ati/ 5islo/ation
o0 the -nee 2oint: a st354 o0
ei=hteen /ases. 6 9one 6oint
3r= +>. 1971H BL:1<29.
18. "e4ers "E7 "oore
,"7 Ear1e4 6# 6r. ,ra3>ati/
5islo/ation o0 the -nee 2oint.
6 9one 6oint 3r= +>.
197BHB7:4L04LL.
19. "oore ,". .ra/t3re-
5islo/ation o0 the -nee. Clin
Orthop Relat Res.
1981H1B<:128140.
20. )iall D"7 )3tton R:7
(eatin= 6.. #als4 o0 the
/o>>on pero-neal ner1e
a0ter tra3>ati/ 5islo/ation o0
the -nee. 6 9one 6oint 3r=
9r. 200BH87:<<4<<7.
21. #eltola &(7 %in5ahl 67
Eietaranta E7 (os-inen (.
(nee 5islo-/ation in
o1er?ei=ht patients. +6R
+> 6 Roent=enol. 2009H
192:10110<.
22. #lan/her (D7 ilis-i 6.
%on=-ter> 03n/tional res3lts
an5 /o>-pli/ations in
patients ?ith -nee
5islo/ations. 6 (nee 3r=.
2008H 21:2<12<8.
2L. #rasa5 +R7 te/- 6(7
Dellon +%. 8one o0 tra/tion
in23r4 o0 the /o>>on
peroneal ner1e. +nn #last
3r=. 2007HB9:L02L0<.
24. Ri/hter "7 9os/h $7
:ipper>ann 97 Eo0>ann +7
(rette- C. Co>parison o0
s3r=i/al repair or
re/onstr3/tion o0 the /r3/iate
li=a>ents 1ers3s nons3r=i/al
treat>ent in patients ?ith
tra3>ati/ -nee 5islo/ations.
+> 6 ports "e5.
2002HL0:718727.
2B. /hen/- R.
Classi0i/ation o0 -nee
5islo/ations. Oper ,e/h
ports "e5. 200LH11:19L
198.
2<. isto D67 :arren R..
Co>plete -nee 5islo/ation: a
0ollo?-3p st354 o0 operati1e
treat>ent. Clin Orthop Relat
Res. 198BH198:94101.
27. ,?a55le 9C7 9i5?ell
,+7 Chap>an 6R. (nee
5islo/ations: ?here are the
lesionsU + prospe/ti1e
e1al3ation o0 s3r=i/al
0in5in=s in <L /ases. 6
Orthop ,ra3>a.
200LH17:198202.
28. Ma3=han D:. &00e/ts
o0 a51an/in= a=e on
peripheral ner1e
re=eneration. 6 Co>p
)e3rol. 1992HL2L:2192L7.
29. :as/her DC7 D1irna-
#C7 DeCoster ,+. (nee
5islo/ation: initial
assess>ent an5 i>pli/ations
0or treat>ent. 6 Orthop
,ra3>a. 1997H11:B2BB29.
L0. :erier 67 (eatin= 6.7
"ee- R). Co>plete
5islo/ation o0 the -nee: the
lon= ter> res3lts o0
li=a>ento3s re/onstr3/tion.
(nee. 1998HB:2BB2<0.
12
3
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.