Reconstruction of the Acute Isolated Common Peroneal Nerve Palsy Using Primarily Nerve Repair and/or Nerve Graft: A...

Drop foot is a devastating problem in patients with common peroneal nerve palsy (CPN). The standard surgical treatments are categorized into three main categories: nerve-related procedures, tendon transfers, and functioning free muscle reconstruction. The outcomes of nerve surgeries such as neurolysis, nerve repair, transfer, or graft remain controversial. In this study, we present our experience in acute CPN palsy, employing neurolysis, nerve repair, and nerve grafting in a single institution.

Between 1980 and 2016, 50 patients with CPN injury underwent either primary nerve repair, neurolysis, or nerve graft. Thirty-eight patients met our final inclusion criteria. The functional outcomes of CPN injury were reviewed, categorizing surgical outcomes into three groups based on total ankle ROM and muscle strength. Those with total ROM less than 20 or < M2 muscle strength, 20 to 30 or ≥M2, and ≥30 degrees or ≥M3 were believed to have poor, good, and excellent outcomes, respectively.

Nerve grafts shorter than 6 cm are associated with better functional outcome in CPN. Seventy-one percent of patients with nerve grafts shorter than 6 cm achieved good-excellent functional results. Furthermore, 100% of patients in the neurolysis and primary nerve repair groups achieved excellent functional outcomes.

CPN surgery is often associated with underwhelming outcomes. With appropriate patient selection and meticulous surgical techniques, one could expect acceptable outcomes in such a patient population. The correct diagnosis and early intervention, along with postoperative immobilization and aggressive rehabilitation, are crucial for improving the outcomes.