Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

Partial tibial nerve transfer to the motor branches of tibialis anterior is an emerging reconstructive technique for the treatment of traumatic common peroneal nerve (CPN) injury; however, few papers in the literature describe clinical outcomes.

A prospective single-surgeon series of nine consecutive patients who underwent partial tibial nerve transfers to the motor branches of tibialis anterior for traumatic CPN injuries between 2008 and 2014. Eight patients were male and the average age at operation was 28.2 years old (range 21-39). All nine patients experienced high-energy CPN injuries. The average time to operation was 5.8 months (range 1-10) and all patients scored M0 for ankle dorsiflexion preoperatively according to the Medical Research Council (MRC) grading system. Outcome parameters included time since operation, postoperative MRC grade for ankle dorsiflexion, and the use of an orthosis for walking.

Seven of nine patients achieved an MRC grade of ≥M4, allowing for active dorsiflexion against gravity and some resistance, by a mean of 16.7 months postoperatively (range 8-26) and no longer required an orthosis for walking. No complications were recorded during the procedures, nor were any compromises to the tibial nerve donor site during follow-up. No patients were lost to follow-up with an average follow-up period of 30.8 months (range 15-61).

This series provides good evidence that this evolving reconstructive technique may achieve excellent results and should be considered in traumatic common peroneal nerve injuries that would traditionally rely on conventional nerve grafting alone.