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Posterior tibial tendon transfer improves function for foot drop after knee dislocation.

Marius Molund1, Lars Engebretsen, Kjetil Hvaal

  • 1Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Box 4950 Nydalen, 0424, Oslo, Norway.

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Summary

Knee dislocations can cause common peroneal nerve injury and foot drop. Posterior tibial tendon transfer is recommended for persistent foot drop after one year, showing good functional outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Neurology
  • Sports Medicine

Background:

  • Knee dislocation frequently involves common peroneal nerve injury, leading to foot drop.
  • Posterior tibial tendon transfer has shown promise for treating foot drop.
  • This study uniquely focuses on knee dislocation as the cause of common peroneal nerve injury.

Purpose of the Study:

  • To determine the incidence of common peroneal nerve paresis after knee dislocation.
  • To assess symptom improvement rates and patient-reported outcomes following treatment.
  • To evaluate the efficacy of posterior tibial tendon transfer for persistent foot drop.

Main Methods:

  • Retrospective analysis of 247 knee dislocation patients (Schenck Classification II-IV).
  • Documented common peroneal nerve injuries and spontaneous resolution rates.
  • Evaluation of patients undergoing posterior tibial tendon transfer for persistent foot drop (no active dorsiflexion at 12 months).
  • Postoperative assessment included AOFAS scores, ankle dorsiflexion strength, and range of motion (ROM).

Main Results:

  • 17% of patients presented with common peroneal nerve paresis.
  • 35% experienced symptom improvement within one year; one improved later.
  • 12 patients treated with posterior tibial tendon transfer showed a mean AOFAS score of 91.
  • Operated side dorsiflexion strength (118 Nm) and ROM (67°) were significantly lower than the unaffected side (284 Nm, 93°).

Conclusions:

  • Posterior tibial tendon transfer is a viable treatment for persistent foot drop after knee dislocation.
  • The procedure yields good functional outcomes as measured by AOFAS scores.
  • Surgical intervention should be considered for patients with no improvement 1 year post-injury.