Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study

Area of Science:

• Orthopedic Surgery
• Neurology
• Biomedical Engineering

Background:

• High tibial osteotomy (HTO) is a common procedure for medial knee osteoarthritis.
• Peroneal nerve injury is a known complication of HTO, potentially leading to long-term disability.
• Early detection of peroneal nerve lesions is crucial for timely intervention and management.

Purpose of the Study:

• To determine the incidence and types of peroneal nerve lesions following Maquet barrel-vault type high tibial valgization osteotomy.
• To compare clinical presentation with electrophysiological findings in detecting peroneal nerve lesions.
• To assess the persistence and potential permanence of these lesions post-surgery.

Main Methods:

• Electrophysiological study including electromyography (EMG) and nerve conduction velocity (NCV) studies.
• Prospective evaluation of 11 patients undergoing HTO for medial gonarthrosis.
• Pre- and postoperative assessments with a minimum 6-month follow-up; contralateral legs served as controls.

Main Results:

• Electrophysiological peroneal nerve lesions were detected in 3 out of 11 patients (27%).
• Lesion types included isolated motor, isolated sensory, and mixed motor-sensory involvement.
• Only one patient was clinically symptomatic; two were detected solely via electrophysiology.
• Detected lesions showed prolonged persistence, with potential for permanence despite absence of clinical symptoms.

Conclusions:

• Electrophysiological methods detect peroneal nerve lesions after HTO at a higher rate than clinical examination alone.
• Mild, subclinical peroneal nerve injuries are common and can be overlooked post-HTO.
• These electrophysiologically identified lesions may persist long-term or become permanent, underscoring the value of electrodiagnostic assessment.