Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma

Jennifer L. Giuffre, Allen Thorp Bishop, Robert J. Spinner, Bruce A Levy, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability. Results One patient regained Grade 4 ankle dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients). Conclusion Our observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)779-790
Number of pages12
JournalClinical Orthopaedics and Related Research
Volume470
Issue number3
DOIs
StatePublished - Mar 2012

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Nerve Transfer
Knee Injuries
Tibial Nerve
Peroneal Nerve
Wounds and Injuries
Ankle
Muscles
Foot
Tendon Transfer
Self-Help Devices
Toes
Gait
Paralysis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

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title = "Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma",
abstract = "Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability. Results One patient regained Grade 4 ankle dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients). Conclusion Our observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.",
author = "Giuffre, {Jennifer L.} and Bishop, {Allen Thorp} and Spinner, {Robert J.} and Levy, {Bruce A} and Shin, {Alexander Yong-Shik}",
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AU - Bishop, Allen Thorp

AU - Spinner, Robert J.

AU - Levy, Bruce A

AU - Shin, Alexander Yong-Shik

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N2 - Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability. Results One patient regained Grade 4 ankle dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients). Conclusion Our observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

AB - Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability. Results One patient regained Grade 4 ankle dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients). Conclusion Our observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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