Current Concepts Review: Common Peroneal Nerve Palsy After Knee Dislocations. (May 2021)

• Record Type: Journal Article
• Authors: Dy, Christopher J.; Inclan, Paul M.; Matava, Matthew J.; Mackinnon, Susan E.; Johnson, Jeffrey E.
• Is Part Of: Foot & ankle international. Volume 42:Number 5(2021)
• Page Start: 658
• Page End: 668
• Publication Date: 2021-05
• Subjects: palsy -- common peroneal nerve -- Bridle procedure -- dislocation -- knee -- foot drop; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100721995421
• Languages: English
• ISSNs: 1071-1007

Abstract

Dislocation of the native knee represents a challenging injury, further complicated by the high rate of concurrent injury to the common peroneal nerve (CPN). Initial management of this injury requires a thorough neurovascular examination, given the prevalence of popliteal artery injury and limb-threatening ischemia. Further management of a knee dislocation with associated CPN palsy requires coordinated care involving the sports surgeon for ligamentous knee reconstruction and the peripheral nerve surgeon for staged or concurrent peroneal nerve decompression and/or reconstruction. Finally, the foot and ankle surgeon is often required to manage a foot drop with a distal tendon transfer to restore foot dorsiflexion. For instance, the Bridle Procedure—a modification of the anterior transfer of the posterior tibialis muscle, under the extensor retinaculum, with tri-tendon anastomosis to the anterior tibial and peroneus longus tendons at the anterior ankle—can successfully return patients to brace-free ambulation and athletic function following CPN palsy. Cross-discipline coordination and collaboration is essential to ensure appropriate timing of operative interventions and ensure maintenance of passive dorsiflexion prior to tendon transfer.