Abstract

Introduction:Peroneal nerve injury resulting in foot drop is reported to occur in 14-40% of knee dislocations, with severity ranging from neurapraxia to complete disruption. Operative interventions traditionally considered for treatment include tendon transfer, nerve graft, or nerve transfer. Few reports have presented comprehensive outcomes following combining these approaches. We report on functional outcomes of two patients who underwent a combined nerve and tendon transfer for the treatment of traumatic peroneal nerve palsy after multiligamentous knee injury.
Methods: Both presented with complete footdrop with sensory deficits after multiligamentous knee injury with no signs of regeneration at <1 year by clinical and electrodiagnostic evaluation. Patients underwent a combined nerve and tendon transfer with the same three Orthopaedic surgeons at a single institution. Outcomes reported at least two-years from combined nerve and tendon transfer surgery include physician reported measures, gait and strength analysis, and patient reported measures as compared to the unaffected side.
Result: Both patients were able to return to activity without functional bracing. Three-dimensional lower extremity kinematics during self-selected level walking demonstrated controlled ankle dorsiflexion and plantarflexion throughout a minimum of five gait cycles, in addition to symmetrical knee and hip-flexion in these combined nerve and tendon transfer patients. On hand-held dynamometry, inversion and eversion remain weak for both patients.
Conclusion: Long-term functional recovery can be achieved after combined nerve and tendon transfer in patients following traumatic peroneal nerve palsy after a multiligamentous knee injury.

Keywords: Reconstructive surgery; Nerve transfer; Tendon transfer; Foot drop; Deep peroneal nerve

Abbreviations:AFO: Ankle-Foot Orthosis; PTT: Posterior Tibial Tendon; FDL: Flexor Digitorum Longus; PTT: Posterior Tibial Tendon; FDL: Flexor Digitorum Longus; ROM: Range of Motion; MARS: Marx Activity Rating Scale