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Common peroneal nerve (CPN) injury is a serious complication following total knee arthroplasty (TKA). We aim to report four patients (five knees) who underwent prophylactic peroneal nerve decompression for severe rigid valgus deformity with or without associated fixed flexion deformity that was not correctable under anaesthesia. The preoperative deformity of 31.1° valgus by femorotibial angle (range 22.6–37.9°) improved to 7.1° valgus (range 4.3–9.1°) postoperatively (p < 0.05). For two knees, varus–valgus constrained was used due to medial laxity and the other three had posterior-stabilised prosthesis. All four patients had normal motor or sensory nerve function of the CPN nerve postoperatively. There was a significant improvement in the functional outcome by knee society score and knee society functional score from 17.8 ± 6.8, 25 ± 16.2 to 84 ± 8.7, 83 ± 10.3, respectively (p < 0.05). No complications were noted in the mean follow-up of 1.2 years. Prophylactic peroneal nerve decompression allows safe, adequate and optimal lateral soft-tissue release. It is effective in preventing common peroneal nerve palsy in high-risk patients like severe valgus and flexion deformity during total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, there have been no studies examining peroneal nerve decompression and proximal fibular osteochondroma excision exclusively in patients with multiple hereditary exostoses (MHE). The purpose of this study was to evaluate the indications, complications, and recurrence associated with nerve decompression and proximal fibular osteochondroma excision in patients with MHE., Methods: The records on patients with MHE undergoing peroneal nerve decompression from 2009 to 2023 were retrospectively reviewed. Indications, clinical status, surgical technique, recurrence, and complications were recorded and were analyzed using the Fisher exact test, logistic regression, and the Kaplan-Meier method., Results: There were 126 limbs identified in patients with MHE who underwent peroneal nerve decompression. The most common indications were pain over the proximal fibula, tibialis anterior and/or extensor hallucis longus weakness, and dysesthesias and/or neuropathic pain. Seven cases experienced postoperative foot drop as a complication of the decompression and osteochondroma excision. Logistic regression found significant relationships between complications and excision of anterior osteochondromas (odds ratio [OR], 5.21; p = 0.0062), proximal fibular excision (OR, 14.73; p = 0.0051), and previous decompression (OR, 5.77; p = 0.0124). The recurrence rate was 13.8%, and all recurrences occurred in patients who were skeletally immature at the index procedure. The probability of skeletally immature patients not experiencing recurrence was 88% at 3 years postoperatively and 73% at 6 years postoperatively., Conclusions: Indications for peroneal nerve decompression included neurologic symptoms and pain. The odds of a complication increased with excision of anterior osteochondromas and previous decompression. Recurrence of symptoms following decompression and osteochondroma excision was found exclusively in skeletally immature patients., Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this study. The Article Processing Charge for open access publication was funded by the MHE Research Foundation, Brooklyn, New York. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H983 )., (Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Schwannoma, also known as neurilemmoma or Schwann cell tumor, is one of the most common neoplasms of the nerve sheath which usually appears at the head, neck, or upper extremity. Schwannoma occurrence in the lower extremity originating from the common peroneal nerve is rarely reported according to literary findings. We report a case of a 32-year-old man who presented with a 6-month history of a growing lump in the left knee. MRT revealed a well-defined 9.6 cm × 7.8 cm × 6.5 cm multilobular mass of heterogeneous consistency with areas of necroses with a likely diagnosis of synovial sarcoma. After surgery, a final histopathological assessment of the tumor demonstrated Antoni A and B patterns with nuclear palisading, hallmarks of a schwannoma. Postoperatively the patient suffered a neurological complication-impaired dorsiflexion of the left foot. The patient started immediate physiotherapy in the Department of Rehabilitation. Three weeks after the operation, gradual improvement in neurological function was observed. To date, complete tumor excision combined with microscopic analysis and immunohistochemical staining remains the gold standard in diagnosing and treating a peripheral nerve schwannoma. Moreover, the use of additional nerve monitoring tools during surgery could help to prevent complications., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Superficial peroneal nerve (SPN) injuries happen occasionally during surgical treatment of fibular fracture, lateral ankle ligament repair, etc. These injuries are caused because of the variable location of the SPN. It is the injuries are usually treated by steroid injections or anticonvulsants. However, neural symptoms may not respond to treatment and may persist and progress to a painful neuroma. Intractable pain may need surgical treatment. We examined two cases of iatrogenic postoperative SPN injury, and we treated them with transection of the SPN and the intraosseous transposition of the proximal nerve stump using the thrombin-fibrinogen complex with satisfactory outcomes. We report these two cases with a review of the relevant literature. [ABSTRACT FROM AUTHOR]

Peroneal nerve palsy (PNP) and peroneal nerve dysfunction (PND) are rare complications after total knee arthroplasty (TKA). Although PND tends to manifest as transient lateral leg paresthesias that are associated with knee motion, PNP has characteristic motor deficits, including loss of ankle dorsiflexion and eversion strength. Although PND can manifest days, weeks, or months after surgery, delayed cases of PNP have not been well documented. We describe a 72-year-old woman with a delayed case of sudden-onset PNP 10 weeks after TKA. She had no neurologic deficits preoperatively and was recovering uneventfully at 2 and 6 weeks postoperatively. At 10 weeks, she reported insidious onset of drop foot and sensory changes to the lateral leg and dorsum of the foot. Motor deficits included significant loss of ankle dorsiflexion and eversion strength. After a diagnosis of PNP was confirmed with electrodiagnostic studies and lumbar pathology was ruled out with lumbar magnetic resonance imaging, surgical decompression of the peroneal nerve was performed. By 7 weeks after surgical decompression, she had no sensory deficits and nearly full strength in ankle dorsiflexion and eversion. This case shows that PNP can occur several weeks to months outside of the currently documented timeline. Although PNP is an uncommon risk of TKA, it is important to recognize and treat it when it occurs among patients with significant motor and sensory deficits along the distribution of the peroneal nerve postoperatively. [Orthopedics. 2022;45(6):e342-e344.]. [ABSTRACT FROM AUTHOR]

Background: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse., Observations: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient's family reported subjective improvement in lower extremity mobility and plantar flexion., Lessons: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.

Objective: Common peroneal nerve (CPN) injury is a frequently encountered lower extremity injury. Furthermore, several previous studies have demonstrated that patients who underwent direct suturing of the CPN following rupture experienced unfavorable postoperative prognoses. Therefore, we aimed to present a novel modified surgical approach for CPN rupture and assess the effectiveness of this technique in restoring lower limb functionality., Methods: In this retrospective observational study, we included patients with CPN rupture who underwent one-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap for CPN rupture between January 2016 and December 2020. Lower limb function was evaluated using the lower extremity functional scale (LEFS) and British Medical Research Council (BMRC) grading system. We also assessed the influence of age, sex, duration of symptoms, mechanism of injury, and surgical modality on the postoperative recovery of lower extremity function using subgroup and regression analyses., Results: Thirty-seven patients (mean age = 35.76 ± 13.01 years) with at least 2 years of follow-up were included in the final analysis. The LEFS scores significantly improved after surgery at the last follow-up (p < 0.01). Moreover, 67.57% of the patients achieved good or excellent postoperative outcomes (BMRC: M3 or above). Results of the subgroup analysis and regression models suggested that patients who underwent direct suturing showed better recovery of lower extremity function than those who underwent nerve grafting., Conclusion: One-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap exhibited encouraging outcomes in restoring lower-limb function among patients with CPN rupture. This novel surgical technique is expected to be an effective method for treating CPN ruptures in the future., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

The article discusses research which focused on the safe administration of radiofrequency ablation (RFA) of the recurrent fibular nerve to treat chronic anterior inferolateral knee pain. Topics explored include the proper positioning of the patient prior to the procedure, the variability in electrode tip positioning which will depend on the RFA technology to be utilized, and the outcomes recorded following treatment.

Background: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) procedures have been shown to improve patient-reported outcomes for the treatment of symptomatic neuromas after amputation; however, the specific indications and comparative outcomes of each are unclear. The primary research questions were what complement of nerves most frequently requires secondary pain intervention after conventional amputation, whether this information can guide the focused application of TMR and RPNI to the primary amputation setting, and how the outcomes compare in both settings.Methods: We performed a retrospective review of records for patients who had undergone lower-extremity TMR and/or RPNI at our institution. Eighty-seven procedures were performed: 59 for the secondary treatment of symptomatic neuroma pain after amputation and 28 for primary prophylaxis during amputation. We reviewed records for the amputation level, TMR and/or RPNI timing, pain scores, patient-reported resolution of nerve-related symptoms, and complications or revisions. We evaluated the relationship between the amputation level and the frequency with which each transected nerve required neurologic intervention for pain symptoms.Results: The mean pain score decreased after delayed TMR or RPNI procedures from 4.3 points to 1.7 points (p < 0.001), and the mean final pain score (and standard deviation) was 1.0 ± 1.9 points at the time of follow-up for acute procedures. Symptom resolution was achieved in 92% of patients. The sciatic nerve most commonly required intervention for symptomatic neuroma above the knee, and the tibial nerve and common or superficial peroneal nerve were most problematic following transtibial amputation. None of our patients required a revision pain treatment procedure after primary TMR targeting these commonly symptomatic nerves. Failure to address the tibial nerve during a delayed procedure was associated with an increased risk of unsuccessful TMR, resulting in a revision surgical procedure (odds ratio, 26 [95% confidence interval, 1.8 to 368]; p = 0.02).Conclusions: There is a consistent pattern of symptomatic nerves that require secondary surgical intervention for the management of pain after amputation. TMR and RPNI were translated to the primary amputation setting by using this predictable pattern to devise a surgical strategy that prevents symptomatic neuroma pain.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Introduction: Hereditary multiple exostosis, also known as Ombredanne's Disease is a rare autosomal dominant condition which typically affects prepubescent children. It presents several benign bone excrescences known as osteochondromas, mainly concerning the flat bones and the epiphysis of long bones. One of the most frequent complications is nerve compression caused by the exostoses, potentially leading to permanent nerve damage and paralysis Case Report: We bring forward the case of a 14-year-old patient who was admitted to the Paediatric Surgery and Orthopaedics Department in Targu Mures with Hereditary Multiple Osteochondromatosis diagnosed 2 years prior to their current admission, with a medical record of multiple interventions, including excisions of exostoses from the left scapula, distal bilateral femoral epicondyles and fibular heads with complete removal of the proximal end of both fibulas. Histopathological examination revealed multiple osteochondromas without malignant degeneration. The last consultation revealed that reintervention was necessary due to reduced mobility in the lower left limb, with incapacity of executing dorsal flexion of the foot and paraesthesia along its dorsal aspect and lateral side of the leg. EMG investigation revealed bilateral common peroneal nerve axonal neuropathy with a more severe impairment and stagnation on the left side and a slow, but favourable evolution on the right. An external neurolysis procedure was performed by a multidisciplinary team formed with the Plastic Surgery Compartment in order to release the common peroneal nerve. An "S-shaped" incision was made on the lateral proximal half of the leg with excision of the old scar and after proper dissection, extended thick fibrous tissue was revealed, that enveloped the underlying structures causing local compression. Further dissection was needed to ensure complete release on the full length of the common peroneal nerve from the scar tissue formed after multiple surgical interventions. Afterwards, it was transpositioned posteriorly in the popliteal fossa with the wound being closed in anatomical planes and an intradermic suture. Discussions : The patient had a favourable postoperative outcome. The wound was clean with no apparent signs of local complications and in just 3 weeks post-procedure, the patient started showing signs of improvement with mobility in the lower left limb. Conclusions: Due to the progressive nature of the disease until puberty, patients are prone to undergo multiple surgeries. Regular screening, in anticipation of newly grown exostoses and possible complications, such as nerve compression syndromes, is mandatory in order to prevent impending progression to irreparable paralysis [ABSTRACT FROM AUTHOR]

Background: Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients' prognosis.Methods: This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results: The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR = 3.35), occupation("blue trouser" worker vs "white-trouser" worker, OR = 4.39), diabetes (OR = 11.68), cardiovascular disease (OR = 51.35), knee joint dislocation (OR = 14.91), proximal fibula fracture (OR = 3.32), tibial plateau fracture (OR = 9.21), vascular injury (OR = 5.37) and hip arthroplasty (OR = 75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR = 0.18) and postoperative knee joint immobilization (OR = 0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863-0.946.Conclusions: Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factors of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN. [ABSTRACT FROM AUTHOR]

Purpose: The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis., Methods: Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified., Results: The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41)., Conclusion: Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Background: This study aims to assess the recovery patterns and factors influencing outcomes in patients with common peroneal nerve (CPN) injury., Methods: This retrospective study included 45 patients with CPN injuries treated between 2009 and 2019 in Jing'an District Central Hospital. The surgical interventions were categorized into three groups: neurolysis (group A; n = 34 patients), nerve repair (group B; n = 5 patients) and tendon transfer (group C; n = 6 patients). Preoperative and postoperative sensorimotor functions were evaluated using the British Medical Research Council grading system. The outcome of measures included the numeric rating scale, walking ability, numbness and satisfaction. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal time interval between injury and surgery for predicting postoperative foot dorsiflexion function, toe dorsiflexion function, and sensory function., Results: Surgical interventions led to improvements in foot dorsiflexion strength in all patient groups, enabling most to regain independent walking ability. Group A (underwent neurolysis) had significant sensory function restoration (P < 0.001), and three patients in Group B (underwent nerve repair) had sensory improvements. ROC analysis revealed that the optimal time interval for achieving M3 foot dorsiflexion recovery was 9.5 months, with an area under the curve (AUC) of 0.871 (95% CI = 0.661-1.000, P = 0.040). For M4 foot dorsiflexion recovery, the optimal cut-off was 5.5 months, with an AUC of 0.785 (95% CI = 0.575-0.995, P = 0.020). When using M3 toe dorsiflexion recovery or S4 sensory function recovery as the gold standard, the optimal cut-off remained at 5.5 months, with AUCs of 0.768 (95% CI = 0.582-0.953, P = 0.025) and 0.853 (95% CI = 0.693-1.000, P = 0.001), respectively., Conclusions: Our study highlights the importance of early surgical intervention in CPN injury recovery, with optimal outcomes achieved when surgery is performed within 5.5 to 9.5 months post-injury. These findings provide guidance for clinicians in tailoring treatment plans to the specific characteristics and requirements of CPN injury patients., (© 2024. The Author(s).)

The fibrotic tissue that appears following nerve damage can prevent axonal regeneration. Expanded polytetrafluor ethylene (ePTFE) is a synthetic polymer with antiadhesive properties and a safe history of use in neurosurgery. The aim of this study was to use ePTFE to prevent postsurgical adhesions in patients undergoing anastomosis surgery and report the results. Between January 2014 and May 2018, six patients with primary and secondary peripheral nerve cuts underwent anastomosis (one with allograft and five with autografts). The anastomotic region was wrapped with ePTFE to form a barrier. The mean follow-up period was 28 months (minimum 3 months, maximum 4 years). In three of six patients whose nerve integrity was lost due to various reasons, there was an improvement in electrophysiological recordings. The allograft was used in a patient with peroneal nerve injury; the sural nerve was used as a graft in other patients. In three patients, the defect was more than 4 cm. Early surgery and defect size are important factors to consider when treating peripheral nerve anastomosis. Development of intraneural and perineural adhesions postsurgery can be problematic. ePTFE is an inert polymer that prevents adhesions from forming after anastomosis surgery. [ABSTRACT FROM AUTHOR]

Objective: Compared to the upper limb, lower limb distal nerve transfer (DNT) outcomes are poor, likely due to the longer length of regeneration required. DNT surgery to treat foot drop entails rerouting a tibial nerve branch to the denervated common fibular nerve stump to reinnervate the tibialis anterior muscle for ankle dorsiflexion. Conditioning electrical stimulation (CES) prior to nerve repair surgery accelerates nerve regeneration and promotes sensorimotor recovery. We hypothesize that CES prior to DNT will promote nerve regeneration to restore ankle dorsiflexion.Methods: One week following common fibular nerve crush, CES was delivered to the tibial nerve in half the animals, and at 2 weeks, all animals received a DNT. To investigate the effects of CES on nerve regeneration, a series of kinetic, kinematic, skilled locomotion, electrophysiologic, and immunohistochemical outcomes were assessed. The effects of CES on the nerve were investigated.Results: CES-treated animals had significantly accelerated nerve regeneration (p < 0.001), increased walking speed, and improved skilled locomotion. The injured limb had greater vertical peak forces, with improved duty factor, near-complete recovery of braking, propulsive forces, and dorsiflexion (p < 0.01). Reinnervation of the tibialis anterior muscle was confirmed with nerve conduction studies and immunohistochemical analysis of the neuromuscular junction. Immunohistochemistry demonstrated that CES does not induce Wallerian degeneration, nor does it cause macrophage infiltration of the distal tibial nerve.Interpretation: Tibial nerve CES prior to DNT significantly improved functional recovery of the common fibular nerve and its muscle targets without inducing injury to the donor nerve. ANN NEUROL 2020;88:363-374. [ABSTRACT FROM AUTHOR]

Purpose: Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair.Methods: Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve.Results: Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen.Conclusions: The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique. [ABSTRACT FROM AUTHOR]

Ganglion cysts are relatively common, but intraneural ganglion cysts (INGCs) within peripheral nerves are rare and poorly understood. We present the case of a 58-year-old woman who presented with acute right-foot drop. She experienced acute knee pain radiating from the lateral leg to the dorsal foot two days after the first coronavirus disease-19 (COVID-19) vaccination (BNT162b2, Pfizer-BioNTech). She had no history of trauma or medication use. Two weeks after the onset of symptoms, she developed a dorsiflexor weakness of the right foot (Medical Research Council grade, poor). The weakness worsened to a "trace" grade despite providing conservative management for one month. Ultrasonography revealed a fusiform echolucent structure within the course of the right common peroneal nerve around the fibular head. Magnetic resonance imaging revealed multiple intraneural cysts within the right common peroneal nerve. Nerve conduction and electromyographic studies revealed multiphasic motor unit action potentials accompanied by abnormal spontaneous activities in the innervated muscles, along with axonal degeneration of the deep peroneal nerves. Surgical removal of the cyst was performed, and the patient's symptoms gradually improved. Pathological examination revealed a cystic structure containing mucinous or gelatinous fluid and lined with flattened or cuboidal cells. The clinical course and sequential electromyographic findings relevant to this symptomatic cyst were temporally related to the vaccination date. The present case suggests that INGC-induced peroneal palsy is a possible complication after COVID-19 vaccination.

Case: A 28-year-old male patient who injured his ankle 2 years ago presented with unilateral ankle pain, tingling, and numbness for 1 year. Clinically, tenderness and positive Tinel sign were localized on anterior aspect of ankle. On exploration, deep peroneal nerve and mainly its articular branch were encased in fibrotic tissue. Decompression of both nerves resulted in symptomatic relief after surgery., Conclusion: High index of suspicion, a thorough medical history, meticulous clinical examination, complete knowledge of nerve anatomy, proper radiological studies, and careful surgical decompression are all necessary for the diagnosis and management of such atypical cases., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C261)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Peripheral nerve injuries due to mass effect from bony lesions can occur when the nerve exists in an anatomically constrained location, such as the common peroneal nerve at the fibular head which passes into the tight fascia of the lateral leg compartment. We report a case of a pediatric patient who developed a common peroneal nerve palsy secondary to an osteochondroma of the fibular head and describe the clinical evaluation, radiographic findings, and surgical approach. Rapid diagnosis and nerve decompression after the onset of symptoms restored full motor function at the 8-month postoperative mark., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

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Introduction: Damage to the common peroneal nerve is the most frequent nerve injury in lower limb traumas. Our objective was to assess the motor and sensory recovery levels and the functional outcomes after remedial surgery for common peroneal nerve trauma, through either neurolysis, direct suture or nerve graft. Methods: This is a transversal, observational study of a monocentric cohort of 20 patients who underwent surgery between January 2004 and June 2016, which included 16 men and 4 women whose median age was 35 ± 11 years. We assessed the level of sensory and motor nerve recovery and the Kitaoka score. Nine patients benefited from neurolysis, 5 had direct sutures, and 6 received a nerve graft. Results: With 48 months' average follow-up, 7 out of 9 patients underwent neurolysis and 4 out of 5 with direct sutures had good motor recovery (≥ M4), but none for the grafts. Sensory recovery (≥ S3) was satisfactory in 7 out of 9 cases in the neurolysis group, 3 out of 5 in the direct suture group, and 3 out of 6 in the nerve graft group. The average Kitaoka score was 83.7 ± 11.5 for the neurolysis group, 86.8 ± 16 for the direct suture group, and 73 ± 14 for the graft group. Conclusion: Surgical treatment by neurolysis and direct suture yields good results with a motor recovery ratio nearing 80%. When a nerve graft becomes necessary, recovery is poor and resorting to palliative techniques in the shorter run is a strategy which should be evaluated. [ABSTRACT FROM AUTHOR]

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., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

Schwannoma is a benign tumour of Schwann cells originating from myelin sheath of axons of the nerves. It is usually seen in the vestibular region, very rarely found in extremity regions. Schwannomas are termed 'Giant' when they measure more than five centimetres in a minimum of one dimension. Giant schwannomas in the foot and ankle region are extremely uncommon. Only eight cases of such a condition are reported. This is a case report of a giant schwannoma found arising from the superficial peroneal nerve in the dorsolateral aspect of the foot. This swelling was excised completely and the diagnosis was confirmed by histopathology., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The objective of this study was to answer the typical questions from patients regarding the likely neurologic outcome and likelihood of recurrence when discussing peroneal intraneural ganglion cysts preoperatively.Methods: Retrospective analysis of all patients who underwent surgery for a peroneal intraneural ganglion cyst between January 1, 2000, and April 1, 2017, was performed. Postoperative neurologic outcomes and radiologic recurrences are reported.Results: There were 65 patients. Average clinical follow-up was 14 months. Median dorsiflexion and eversion preoperatively were 2/5 and 4/5, respectively. Median dorsiflexion and eversion at last follow-up postoperatively were 5/5. Radiologic recurrence occurred in 6 (9%) patients, all extraneural.Discussion: The data support excellent postoperative motor outcomes, despite frequent dense weakness of peroneal-innervated musculature preoperatively. The surgical approach appears to eliminate risk of intraneural recurrence and minimizes risk of extraneural recurrence. Muscle Nerve 57: 989-993, 2018. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the distances between the incision and neurovascular structures in direct posterior split-gastrocnemius approach for tibial plateau fractures.Methods: Thirteen fresh-frozen cadavers were used in the study. The distance between the neurovascular structures medial and lateral to the incision was measured from the tibial joint line and at a level 5 cm distal to the joint line.Results: The mean distance between the incision and medial neurovascular structures was 10.09 ± 3.47 mm (range 5.63-16.51 mm) at the level of the tibial joint line and 10.39 ± 2.57 mm (range 5.79-14.09 mm) at a level 5 cm distal to the joint line. The mean distance between the incision and the common peroneal nerve was 13.44 ± 4.17 mm (range 6.28-20.72 mm) at the level of the tibial joint line and 19.56 ± 5.24 mm (range 12.58-26.74 mm) at a level 5 cm distal to the joint line.Conclusions: In isolated posterolateral tibial plateau fractures, it is possible to apply anatomical reduction and buttress plating on the posterior surface with a direct posterior split-gastrocnemius approach. With a thorough understanding of the regional anatomy, this approach can be safely performed by experienced orthopaedists. [ABSTRACT FROM AUTHOR]

Background: Primary benign and malignant tumors of the proximal fibula are not very common. Upper fibula being an expendable bone; the majority of the primary bone tumors at this site are usually treated with en bloc proximal fibulectomy. There is scarce literature on functional results, difficulties faced during dissection when to preserve or sacrifice common peroneal nerve and importance of lateral collateral ligament repair after proximal fibulectomy. The present study attempts at assessing these variables. Materials and Methods: This retrospective study included 46 patients; 30 males and 16 females with age ranging from 12 to 44 years (average: 26 years) operated between 2003 and 2014. There were 34 benign and 12 malignant tumors. All were treated with proximal en bloc fibulectomy as indicated and decided by the operating surgeon keeping in view its extent on magnetic resonance imaging. Peroneal nerve sacrifice or preservation was decided as per the type (benign/malignant), its involvement by the tumor and the extent of the tumor. In 14 (for 12 malignant and two benign giant cell tumors [GCTs]) patients, the peroneal nerve required resection for the margins. Partial upper tibial resection was performed in cases of malignant tumors and three GCTs. The followup ranged between 24 and 120 months (median: 48 months). Results: Patients with peroneal nerve resection had inferior functional outcome than those without peroneal nerve resection. There was no higher risk of tibia fracture in patients with partial tibial resection. Lateral collateral reconstruction yielded better results and should be performed in all cases. Functional outcome was significantly better in patients with benign tumors than in patients with malignant tumors as these required neither resection of the peroneal nerve nor large amount of muscle excision. The functional results were evaluated using Musculoskeletal Tumor Society (MSTS) score, and clinical outcomes were evaluated using knee and ankle movements and stability. The overall average MSTS score was 26.50. Conclusions: With good reconstruction of lateral ligament we can achieve good results after proximal fibulectomy for benign as well as malignant tumor without much instability. With partial upper tibial resection (i.e., the extra-articular resection of proximal tibiofibular joint) adequate margins are feasible even in malignant tumors. [ABSTRACT FROM AUTHOR]

Background: Common peroneal nerve (CPN) entrapment neuropathy (CPNEN) is the most common peripheral neuropathy of the lower extremities. The pathological mechanisms underlying CPNEN remain unclear. We sought to identify dynamic factors involved in CPNEN by directly measuring the CPN pressure during stepwise CPNEN surgery. Methods: We enrolled seven patients whose CPNEN improved significantly after CPN neurolysis. All suffered intermittent claudication, and the repetitive plantar flexion test, used as a CPNEN provocation test, was positive. During decompression surgery we directly measured the CPN pressure during several decompression steps. Results: Before CPN decompression, plantar flexion elicited a statistically significant increase in the CPN pressure (from 1.8 to 37.3, p < 0.05), as did plantar extension (from 1.8 to 23.1, p < 0.05). The CPN pressure gradually decreased during step-by-step surgery; it was lowest after resection of the peroneus longus muscle (PLM) fascia. Conclusions: Dynamic factors affect idiopathic CPNEN. The CPN pressure decreased at each surgical decompression step, and removal of the PLM fascia resulted in adequate decompression of the CPN. Our findings shed light on the etiology of idiopathic CPNEN and recommend adequate CPNEN decompression procedures. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to report on the rehabilitative outcomes associated with common peroneal nerve (CPN) decompression and neurolysis revision when performed with open surgical implantation of a viable cryopreserved placental membrane (vCPM). Methods: Seven patients who underwent secondary CPN decompression and neurolysis with open surgical implantation of a viable cryopreserved placental membrane (vCPM) after previously failed surgery without vCPM utilization were identified through a retrospective medical record review and outcomes were analyzed. Primary mechanism of injury, severity of symptoms at time of referral, pre-operative and post-operative evaluations on edema with ultrasound, Medical Research Council (MRC) scale for motor strength, range of motion, nerve conduction velocity (NCV), and electromyography (EMG) were analyzed. Results: Five patients (71.4%) achieved full recovery of motor function MRC grade 5/5, and the remaining two patients achieved MRC grade 4/5. At the 7-month follow-up visit, NCV tests indicated improved conduction velocity and normal amplitude for all 7 patients, and all patients demonstrated proper gait pattern with a return to normal activities of daily living. There were no vCPM-related adverse events. Conclusions: The use of vCPM wrap as an adjunct to surgical repairs of CPN injuries may contribute to positive clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Sciatic nerve injury following total hip arthroplasty (THA) predominantly affects the peroneal division of the sciatic nerve, often causing a foot drop. This can result from a focal etiology (hardware malposition, prominent screw, or postoperative hematoma) or nonfocal/traction injury. The objective of this study was to compare the clinicoradiological features and define the extent of nerve injury resulting from these two distinct mechanisms., Methods: Patients who developed a postoperative foot drop within 1 year after primary or revision THA with a confirmed proximal sciatic neuropathy based on MRI or electrodiagnostic studies were retrospectively reviewed. Patients were divided into two cohorts: group 1 (focal injury), including patients with an identifiable focal structural etiology, and group 2 (nonfocal injury), including patients with a presumed traction injury. Patient demographics, clinical examinations, subsequent surgeries, electrodiagnostic study results, and MRI abnormalities were noted. The Student t-test was used to compare time to onset of foot drop and time to secondary surgery., Results: Twenty-one patients, treated by one surgeon, met inclusion criteria (8 men and 13 women; 14 primary THAs and 7 revision THAs). Group 1 had a significantly longer time from THA to the onset of foot drop, with a mean of 2 months, compared with an immediate postoperative onset in group 2 (p = 0.02). Group 1 had a consistent pattern of localized focal nerve abnormality on imaging. In contrast, the majority of patients in group 2 (n = 11) had a long, continuous segment of abnormal size and signal intensity of the nerve, while the other 3 patients had a segment of less abnormal nerve in the midthigh on imaging. All patients with a long continuous lesion had Medical Research Council grade 0 dorsiflexion prior to secondary nerve surgeries compared with 1 of 3 patients with a more normal midsegment., Conclusions: There are distinct clinicoradiological findings in patients with sciatic injuries resulting from a focal structural etiology versus a traction injury. While there are discrete localized changes in patients with a focal etiology, those with traction injuries demonstrate a diffuse zone of abnormality within the sciatic nerve. A proposed mechanism involves anatomical tether points of the nerve acting as points of origin and propagation for traction injuries, resulting in an immediate postoperative foot drop. In contrast, patients with a focal etiology have localized imaging findings but a highly variable time to the onset of foot drop.

The long history of regeneration nerve research indicates many clinical problems with surgical reconstruction to be resolved. One of the promising surgical techniques in specific clinical conditions is end-to-side neurorrhaphy (ETS), described and then repeated with different efficiency in the 1990s of the twentieth century. There are no reliable data on the quality of recipient nerve regeneration, possible donor nerve damage, and epineural window technique necessary to be performed. This research attempts to evaluate the possible regeneration after end-to-side neurorrhaphy, its quality, potential donor nerve damage, and the influence of epineural windows on regeneration efficiency. Forty-five female Wistar rats were divided into three equal groups, and various surgical technics were applied: A-ETS without epineural window, B-ETS with epineural window, and C-free graft reconstruction. The right peroneal nerve was operated on, and the tibial nerve was selected as a donor. After 24 weeks, the regeneration was evaluated by (1) footprint analysis every two weeks with PFI (peroneal nerve function index), TFI (tibial nerve function index), and SFI (sciatic nerve function index) calculations; (2) the amplitude and latency measurements of motor evoked potentials parameters recorded on both sides of the peroneal and tibial nerves when electroneurography with direct sciatic nerve electrical stimulation and indirect magnetic stimulation were applied; (3) histomorphometry with digital conversion of a transverse semithin nerve section, with axon count, fibers diameter, and calculation of axon area with a semiautomated method were performed. There was no statistically significant difference between the groups investigated in all the parameters. The functional indexes stabilized after eight weeks (PFI) and six weeks (TFI and SFI) and were positively time related. The lower amplitude of tibial nerve potential in groups A and B was proven compared to the non-operated side. Neurophysiological parameters of the peroneal nerve did not differ significantly. Histomorphometry revealed significantly lower diameter and area of axons in operated peroneal nerves compared to non-operated nerves. The axon count was at a normal level in every group. Tibial nerve parameters did not differ from non-operated values. Regeneration of the peroneal nerve after ETS was ascertained to be at the same level as in the case of free graft reconstruction. Peroneal nerves after ETS and free graft reconstruction were ascertained to have a lower diameter and area than non-operated ones. The technique of an epineural window does not influence the regeneration result of the peroneal nerve. The tibial nerve motor evoked potentials were characterized by lower amplitudes in ETS groups, which could indicate axonal impairment.

Background : The arthroscopic Broström procedure is a promising treatment for chronic ankle instability. However, little is known regarding the location of the intermediate superficial peroneal nerve at the level of the inferior extensor retinaculum; knowledge about this location is important for procedural safety. The purpose of this cadaveric study was to clarify the anatomical relationship between the intermediate superficial peroneal nerve and the sural nerve at the level of the inferior extensor retinaculum. Methods : Eleven dissections of cadaveric lower extremities were performed. The origin of the experimental three-dimensional axis was defined as the location of the anterolateral portal during ankle arthroscopy. The distances from the standard anterolateral portal to the inferior extensor retinaculum, sural nerve, and intermediate superficial peroneal nerve were measured using an electronic digital caliper. The location of inferior extensor retinaculum, the tract of sural nerve, and intermediate superficial peroneal nerve were checked using average and standard deviations. For the statistical analyses, data are presented as average ± standard deviation, and then they are reported as means and standard deviations. Fisher's exact test was used to identify statistically significant differences. Results : At the level of the inferior extensor retinaculum, the mean distances from the anterolateral portal to the proximal and distal intermediate superficial peroneal nerve were 15.9 ± 4.1 (range, 11.3-23.0) mm and 30.1 ± 5.5 (range, 20.8-37.9) mm, respectively. The mean distances from the anterolateral portal to the proximal and distal sural nerve were 47.6 ± 5.7 (range, 37.4-57.2) mm and 47.2 ± 4.1 (range, 41.0-51.8) mm), respectively. Conclusions : During the arthroscopic Broström procedure, the intermediate superficial peroneal nerve may be damaged by the anterolateral portal; the proximal and distal parts of the intermediate superficial peroneal nerve were located within 15.9 and 30.1 mm, respectively, at the level of the inferior extensor retinaculum in cadavers. These areas should be considered danger zones during the arthroscopic Broström procedure.

Case: An 18-year-old man sustained a peroneal nerve (PN) injury during an all-inside repair of the posterior horn of the lateral meniscus from the medial portal. Although he could dorsiflex his ankle actively after emergence from general anesthesia, he had a foot drop on the day after surgery. Exploration of the PN at 5 months postoperatively revealed that the nerve was entrapped by the suture. Fifteen months after a nerve repair using a sural nerve graft, he recovered from the foot drop., Conclusion: This case report highlights the risk of PN injury during an all-inside repair of the posterior horn of the lateral meniscus., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C21)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Peripheral nerve injuries have severe consequences on quality of life, especially in cases with extensive or old injuries when standard nerve repair is impossible and proposed repair methods are not completely satisfactory. Terminolateral neurorrhaphy is a practical and advantageous technique for nerve repair; therefore, we developed a nerve function study to evaluate advantages of proximal stump coaptation in end-to-side nerve repair method. Methods: Three experimental groups were studied: In group A, the proximal and distal stumps of the transected peroneal nerve were sutured to the posterior tibialis nerve in left side and right side left intact; in group B, a classic end-to-side neurorrhaphy was performed; and group C was without neurorrhaphy as the control group. Five months later, visual functional assessment of sciatic nerves was performed to assess the statistic sciatic index (SSI). Results: The surgical procedures caused an ipsilateral rehabilitation in groups A and B compared with the control group ( p < 0.05). Although comparison of intermediate toe spread factor of distal-proximal nerve repair and distal nerve repair (DNR) was not statistically significant, toe spread factor and subsequently SSI comparisons showed significant statistical difference ( p < 0.05). Discussion: Contribution of proximal nerve stump to DNR improved functional recovery of motor neurons in an end-to-side cooptation method in rat lower extremity. Some of possible explanations for positive results could be the presence of more neuroattractive substances and use of donor nerve epineurium as a neuropermissive bridge for the regenerated axons. [ABSTRACT FROM AUTHOR]

Background: Intraneural ganglia most commonly occur within the peroneal nerve near the fibular neck. Disconnection of the articular branch is required in their treatment. Surgical intervention can be challenging because of unfamiliarity with the region or scarring from previous surgery. Method: We present the layered 'U' technique for peroneal intraneural ganglia with clinical examples. Dissection is carried down in parallel to the U-shaped course of the articular branch to provide optimal visualization and avoid injury to major branches of the nerve. Conclusion: This pathoanatomic approach provides direct and safe exposure of the articular branch of the common peroneal nerve. Key points: • The CPN is the most frequently affected site for IG. • PIG are becomingly increasingly recognized as causes of foot drop []. • PIG can represent an operative challenge, particularly in the setting of previous surgery. • Understanding the consistent U-shape of the AB and its cystic involvement in PIG allows a more efficient dissection. • A U-shaped layered approach exposes the AB. • Dissection superiorly and medially along the AB minimizes risk to the DPN and SPN. • Disconnection of the AB near the STFJ minimizes intraneural cyst recurrence and is the critical part of the procedure. • Cyst decompression may expedite symptom relief. • We have added STFJ resection (disarticulation) to our strategy to further decrease risks for intraneural and extraneural recurrence, as it removes the synovium, the source of STFJ-related ganglia. • This surgical strategy maximizes neurologic improvement and minimizes cyst recurrence. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this study was to analyse the incidence of Common Peroneal Nerve Palsy (CPNP) after Total Knee Arthroplasty (TKA) for all alignments. Secondarily, the efficiency and safety of a Peroneal Nerve Release (PNR) prior to TKA in preoperative severe fixed valgus deformities were evaluated to prevent a CPNP., Methods: Overall, 7612 TKAs were performed in the institution from 2009 to 2021. 1913 TKAs were performed by three surgeons, who consistently performed a PNR in case of a fixed valgus deformity of (1) more than 15°, or (2) more than 10° but in combination with a flexion contracture of more than 15°. Patients with fixed valgus deformities of more than 10° were identified (81 knees) and a comparison was made between the patients who received a PNR (26 knees) and those who did not receive a PNR (55 knees). Data for the analysis were collected from patient medical files and were compared with the Chi 2 -test or Fisher Exact test., Results: A CPNP incidence of 0.2% (16/7612) was found after TKA for all alignments together. No CPNP cases (0%) were developed in the PNR-group, compared to five (9%) in the non-PNR group (p = NS). A larger preoperative valgus angle (17° vs 13°, p < 0.001) and flexion contracture (10° vs 3°, p < 0.001) was present in the PNR group compared with the non-PNR group. No PNR-related complications were reported., Conclusion: The CPNP incidence in this study is consistent with the previous literature. Furthermore, although not significant, the group that received a PNR procedure developed fewer CPNPs compared to the group without PNR., Level of Evidence: Retrospective cohort study, III., (© 2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

One of the most important limiting factors in the long-term success of total knee arthroplasty is polyethylene wear. Particles of the polyethylene inserts have been shown to elicit a foreign body response, which produces bone resorption and osteolysis, ultimately leading to loosening and component failure. The authors report on a case of an elderly patient who underwent a total knee arthroplasty almost 2 decades ago. Clinical and radiological checkups of the knee had not been performed recently. He now presented with a painful and swollen knee, recurrent joint effusion and swelling of the lower leg, and paresis of the peroneal nerve. Radiological examination showed asymmetric wear of the polyethylene insert and pronounced periprosthetic osteolysis of the proximal tibia and the distal femur. Furthermore, a large ganglion on the anterolateral aspect of the lower leg, resulting in pressure on the peroneal nerve, was detected on ultrasound examination. Open excision of the ganglion was performed initially, followed by 1-stage revision knee arthroplasty using a modular system a few weeks later. This case shows a rare but severe long-term complication of total knee arthroplasty and highlights the importance of regular clinical and radiological checkups after total joint replacements, even for asymptomatic patients and especially in the long term (ie, beyond 10 years after implantation). The current case shows that wear of the polyethylene insert may also lead to ganglion formation that causes paresis of the peroneal nerve. [Orthopedics. 2017; 40(3):e538-e540.]. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral nerve injuries are common and can lead to functional disabilities. Thus, studies suggest seek surgical and post-surgical treatment protocols to minimize this frame, reinervado and improve muscle functionality. The atrophy of the muscular fibers occurs depending on the time of axonal regeneration, as with electrostimulation atrophy would be minimized, inducing tissue repair and increasing muscular strength. Objective: To investigate The efficiency of electric stimulation through the Russian Current after end-to-side neurorrhaphy in the repair morphological of the common peroneal nerve in rats. Methods: It were used 40 Wistar rats, males, with 80 days of life, supplied by the Central Animal Facility at the University of the Sacred Heart (USC) (Protocol: 25/14). The animals were randomly divided into five groups of 8 animals each. Initial Control Group (GCI), Final Control Group (GCF), Denervated group (GD), Experimental Group Untreated (GENT), End-to-Side Neurorrhaphy with Russian Stimulation Group (GER). Functional evaluations of all five groups were conducted, comparing them between them. Results: The results of the analysis of the Sciatic Functional Index (SFI) showed that the GER group (-22.12±3.20) showed statistically greater difference when compared to GENT (-25.84±3.71) and, the results of electrophysiological tests showed that GER and GENT statistically greater differences in relation to the average of the results of both the amplitude (mV), 9.04±2.50 and 6.68±0.63, the latency (ms), 2.11±0.16 and 2.11±0.05, respectively. Conclusion: The Russian electrical stimulation was effective in functional recovery of peripheral nerve injuries. [ABSTRACT FROM AUTHOR]

Introduction: when injured peripheral nerves can lead to a high loss of function for the patient. So many studies seek to propose techniques to accelerate functional recovery of a reinervado muscle. Thus, with the discovery of neurorraphy end-toside (NTL), without injury to the donor nerve, brought great contribution because any nerve can be used as donor nerve without damage to this or to the structures innervated by it. However, even with all technical refinement after neurorrhaphy, the time for axonal regeneration determine muscle fiber atrophy. In this context, electrostimulation have been proposed to accelerate the regenerative process, and minimize the functional losses. Objective: This study aimed to investigate the effectiveness of electrical stimulation with Russian current in morphological repair peroneal nerve of rats after end-side neurorraphy. Methodology: we used 50 Wistar rats, males, with 80 days of life, supplied by the Central Vivarium of Sacred Heart University (USC). The animals were randomly divided into five groups: Start Control Group (ICG), Control Group Final (GCF), denervated group (GD) Surgical Control Group (GCC), neurorrhaphy Group Finish-Side with Russian stimulation (GNTLER). Morphometric analyzes were performed nervous tissue of the rats from all five groups by comparing the nerve regeneration across the groups. Results: the GNTLER group showed a statistically significant difference when compared to GCC group associated to the average of the areas of nerve fibers (21.38 µm²/16.00 µm²) and myelin sheaths (14.23 µm²/10.32 µm²). The GNTLER and GCC groups showed no difference in the functional gait analysis. Conclusion: Based on the methodology employed can be concluded that there was improved axonal regeneration and myelination of nerve fibers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Arthroscopic triple fusion has several advantages over open techniques, but its use has yet to become widespread. Preliminary published techniques use five portals with neurovascular risk. Our aim was to assess the safety and efficacy of an alternative lateral two portal technique. Methods: Four cadaveric hindfeet were arthroscopically prepared for a triple fusion using two lateral portals. The distance to relevant subcutaneous nerves was measured as well as the prepared joint surface percentage. Results: Mean distance from mid-lateral portal to the nearest sural nerve branch was 22.3mm (range 20–24mm) and from the dorsolateral portal to the intermediate branch of the superficial peroneal nerve was 7.8mm (range 4–11mm). Mean percentages of joint preparation were 63% (talar head), 62% (navicular), 75% (calcaneum) and 74% (cuboid). Conclusions: Two lateral arthroscopic portals allow adequate joint preparation for triple fusion procedures. The proximity of subcutaneous nerves is important to appreciate when using these portals. [Copyright &y& Elsevier]

Purpose: The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty., Methods: Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of five years. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71 years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography., Results: The follow-up period was at least 24 months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at two years post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18 months postoperatively and three with partial rehabilitation., Conclusion: CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Background: Delayed autologous nerve graft reconstruction is inevitable in devastating injuries. Delayed or prolonged repair time has deleterious effects on nerve grafts. We aimed improving and accelerating nerve graft reconstruction process in a rat long nerve defect model with loop nerve graft prefabrication particularly to utilize for injuries with tissue loss., Methods: Twenty-four Sprague-Dawley rats were allocated into three groups. 1.5 cm long peroneal nerve segment was excised, reversed in orientation, and used as autologous nerve graft. In conventional interpositional nerve graft group (Group 1), nerve defects were repaired in single-stage. In loop nerve graft prefabrication group (Group 2), grafts were sutured end-to-end (ETE) to the proximal peroneal nerve stumps. Distal ends of the grafts were sutured end-to-side to the peroneal nerve stumps 5 mm proximal to the ETE repair sites in first stage. In second stage, distal ends of the prefabricated grafts were transposed and sutured to distal nerve stumps. In staged conventional interpositional nerve graft group (Group 3), grafts were sutured ETE to proximal peroneal nerve stumps in first stage. Distal ends of the grafts and nerve stumps were tacked to the surrounding muscles until the final repair in second stage. Follow-up period was 4 weeks for each stage in Groups 2 and 3, and 8 weeks for Group 1. Peroneal function index (PFI), electrophysiology, and histological assessments were conducted after 8 weeks. P<0.05 was considered significant for statistical analysis., Results: PFI results of Group 1 (-22.75±5.76) and 2 (-22.08±6) did not show statistical difference (p>0.05). Group 3 (-33.64±6.4) had a statistical difference compared to other groups (p<0.05). Electrophysiology results of Group 1 (16.19±2.15 mV/1.16±0.21 ms) and 2 (15.95±2.82 mV/1.17±0.16 ms) did not present statistical difference (p>0.05), whereas both groups had a statistical difference compared to Group 3 (10.44±1.96 mV/1.51±0.15 ms) (p<0.05). Axon counts of Group 1 (2227±260.4) and 3 (2194±201.1) did not have statistical difference (p>0.05), whereas both groups had significantly poor axon counts compared to Group 2 (2531±91.18) (p<0.05)., Conclusion: Loop nerve graft prefabrication improved axonal regeneration without delay. Loop prefabrication can accelerate prolonged regeneration time for the injuries indicating a delayed nerve reconstruction. Higher axon counts derived with loop nerve prefabrication may even foster its investigation in immediate long nerve defect reconstructions in further studies.