Peroneal Nerve Dysfunction Following Vascularized Fibular Epiphyseal Transfer (VFET): A Prospective Case Series Study

In skeletally immature individuals, vascularized epiphyseal transfer allows for reconstruction of complex bony defects while preserving longitudinal growth and providing a reliable articular surface for effective joint function. The shape and size of the proximal fibular epiphysis allow for gradual remodeling of the articular surface, facilitating favorable reconstruction and rehabilitation over time. Moreover, the proximal fibula is highly expandable, with less weight-bearing function, contributing to low donor-site morbidity. However, peroneal nerve dysfunction-related foot drop remains a matter of concern. The purpose of this study was to prospectively evaluate the incidence and recovery of peroneal nerve dysfunction following vascularized fibular epiphyseal transfer.

Sixteen patients were recruited from Assiut University Hospitals. Clinical assessment using the Medical Research Council score and electromyography was performed preoperatively and at 3, 6, 12, and 24 weeks postoperatively to assess tibialis anterior function on the donor side. The study was registered as a clinical trial prior to patient enrollment (ClinicalTrials.gov: NCT05884827).

Four out of 16 patients developed postoperative foot drop with MRC grade 0 but fully recovered (3 by 12 wk and 1 by 24 wk). Electromyographic abnormalities were observed only in these 4 patients and normalized within 24 weeks (1 by 12 wk and 3 by 24 wk).

Peroneal nerve dysfunction-related foot drop following vascularized fibular epiphyseal transfer is usually transient, with clinical and electromyographic recovery occurring in most patients within 6 months.

Level IV.