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Isolated Nerve Grafting for a Young Patient with a Complete Common Peroneal Nerve Palsy Following a Traumatic Knee
Shintaro Mukohara1, Atsuyuki Inui1, Yutaka Mifune1
1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Background:
Common peroneal nerve (CPN) injury following a knee dislocation is a serious problem, and an optimal treatment is yet to be established. We report a case of complete CPN palsy following a knee dislocation treated with sural nerve grafting.
Case:
A 19-year-old man suffered a knee injury during a hurdle race. Diagnosis in a previous hospital revealed a complex ligament injury with CPN palsy. Ten weeks following injury, he was admitted to our institution because of a lack of neurological improvement. Considering the grade 0 results obtained in the manual muscle test (MMT) of tibialis anterior (TA) and extensor hallucis longus (EHL), the patient was diagnosed with complete neurotmesis of CPN, and surgery was performed. Operative findings revealed CPN discontinuity and an extended nerve defect length of 15 cm; therefore, sural nerve grafting was performed to repair the CPN injury. One year postoperatively, a grade 1 result from MMT of TA and EHL indicated a gradual neurological recovery. Three years postoperatively, MMT of TA and EHL showed significant improvement to grade 4+ and grade 4, respectively, and he could walk and jog without a knee brace.
Discussion:
Nerve graft length of >6 cm has shown limited success, and their efficacy for the treatment of CPN palsy following knee dislocations is controversial. However, young patients with complete CPN lesion are more likely to recover regardless of the length of nerve injury. Therefore, in such cases, nerve grafting can be considered as one of the treatments for complete CPN lesion following knee dislocations.
