Common peroneal nerve alterations associated with injuries to the posterolateral corner of the knee: how can we contribute?

Abstract Objective: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.

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Management and Outcomes in 318 Operative Common Peroneal Nerve Lesions at the Louisiana State University Health Sciences Center

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/s1535-1513(08)70332-1 ◽

2006 ◽

Vol 2006 ◽

pp. 92-93

Author(s):

D.J. Smith

Keyword(s):

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Health Sciences ◽

State University ◽

Nerve Lesions ◽

Louisiana State University

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Common Peroneal Nerve Palsy After Grade I Inversion Ankle Sprain

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2012.0261 ◽

2012 ◽

Vol 21 (04) ◽

pp. 261-265 ◽

Cited By ~ 6

Author(s):

Evanthia A. Mitsiokapa ◽

Andreas F. Mavrogenis ◽

Dimitris Antonopoulos ◽

George Tzanos ◽

Panayiotis J. Papagelopoulos

Keyword(s):

Ankle Sprain ◽

Peroneal Nerve ◽

Nerve Palsy ◽

Common Peroneal Nerve ◽

Peroneal Nerve Palsy ◽

Common Peroneal Nerve Palsy

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The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03708-9 ◽

2021 ◽

Author(s):

Erik Hohmann ◽

Reinette Van Zyl ◽

Vaida Glatt ◽

Kevin Tetsworth ◽

Natalie Keough

Keyword(s):

Clinical Significance ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Proximal Fibula ◽

Anatomical Relationship ◽

The Common ◽

Relationship Of

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Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716602 ◽

2020 ◽

Author(s):

Kenan Kıbıcı ◽

Berrin Erok ◽

Akın Onat

Keyword(s):

Peroneal Nerve ◽

Imaging Modality ◽

Axonal Neuropathy ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Intraneural Ganglion ◽

Articular Branch ◽

Ankle Eversion ◽

Adjacent Structures ◽

Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

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Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Arthroscopy Techniques ◽

10.1016/j.eats.2021.01.039 ◽

2021 ◽

Author(s):

Miguel Estuardo Rodríguez-Argueta ◽

Carlos Suarez-Ahedo ◽

César Alejandro Jiménez-Aroche ◽

Irene Rodríguez-Santamaria ◽

Francisco Javier Pérez-Jiménez ◽

...

Keyword(s):

Peroneal Nerve ◽

Tendon Transfer ◽

Common Peroneal Nerve ◽

Posterior Tibial Tendon ◽

Drop Foot ◽

Posterior Tibial ◽

Anterior Tibial ◽

Anterior Tibial Tendon ◽

Peroneal Nerve Injury ◽

Improve Reliability

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Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

International Journal of Molecular Sciences ◽

10.3390/ijms22031401 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1401

Author(s):

Rui D. Alvites ◽

Mariana V. Branquinho ◽

Ana C. Sousa ◽

Federica Zen ◽

Monica Maurina ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Small Sample ◽

Therapeutic Options ◽

Nerve Injuries ◽

Sheep Model ◽

The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

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