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Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears.
Orthop Traumatol Surg Res. 2010 Feb; 96(1):64-9.OT

Abstract

INTRODUCTION

The occurrence rate of common peroneal nerve (CPN) palsy associated with knee dislocation or bicruciate ligament injury ranges from 10 to 40%. The present study sought first to describe the anatomic lesions encountered and their associated prognoses and second to recommend adequate treatment strategy based on a prospective multicenter observational series of knee ligament trauma cases.

MATERIAL AND METHODS

Twelve out of 67 knees treated for dislocation or bicruciate lesion presented associated CPN palsy: two females, 10 males; mean age, 32 years. Four sports injuries,three traffic accidents and five other etiologies led to seven complete dislocations and five bicruciate ruptures. Four cases involved associated popliteal artery laceration ischemia; one of the dislocations was open. Paralysis was total in eight cases and partial in four. There were two complete ruptures, three contusions with CPN in continuity stretch lesions and three macroscopically normal aspects.

RESULTS

At a minimum 1 year's follow-up, regardless of the initial surgical technique performed,recovery was complete in six cases, partial (in terms of motor function) in one and absent in five. Without specific CPN surgery, spontaneous recovery was partial in one case, complete in two and absent in none. Following simple emergency or secondary neurolysis, remission was total in four cases and absent in one. Three nerve grafts were all associated with non-recovery.

DISCUSSION

The present results agree with literature findings. Palsy rates varied with trauma circumstances and departmental recruitment. Neurologic impairment was commensurate to ligamentary damages. The anatomic status of the CPN, subjected to violent traction by dislocation,was the most significant prognostic factor for neurologic recovery. In about 25% of dislocations, contusion-elongation over several centimeters was associated with as poor a prognosis as total rupture. CPN neurolysis is recommended when early clinical and EMG recovery fails to progress and/or in case of lateral ligamentary reconstruction. Possible peripheral nerve impairment needs to be included in the overall functional assessment of treatment for severe ligaments injuries and knee dislocation.

LEVEL OF EVIDENCE

Level IV, prospective study.

Authors+Show Affiliations

Unité de traumatologie-orthopédie de Purpan, institut de l'appareil locomoteur, CHU de Toulouse, Blace Baylac, Toulouse 31052 cedex, France. bonnevialle.p@chu-toulouse.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

20170859

Citation

Bonnevialle, P, et al. "Common Peroneal Nerve Palsy Complicating Knee Dislocation and Bicruciate Ligaments Tears." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 96, no. 1, 2010, pp. 64-9.
Bonnevialle P, Dubrana F, Galau B, et al. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res. 2010;96(1):64-9.
Bonnevialle, P., Dubrana, F., Galau, B., Lustig, S., Barbier, O., Neyret, P., Rosset, P., & Saragaglia, D. (2010). Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthopaedics & Traumatology, Surgery & Research : OTSR, 96(1), 64-9. https://doi.org/10.1016/j.rcot.2009.12.004
Bonnevialle P, et al. Common Peroneal Nerve Palsy Complicating Knee Dislocation and Bicruciate Ligaments Tears. Orthop Traumatol Surg Res. 2010;96(1):64-9. PubMed PMID: 20170859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. AU - Bonnevialle,P, AU - Dubrana,F, AU - Galau,B, AU - Lustig,S, AU - Barbier,O, AU - Neyret,P, AU - Rosset,P, AU - Saragaglia,D, AU - ,, PY - 2009/11/05/received PY - 2009/11/13/accepted PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/5/28/medline SP - 64 EP - 9 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 96 IS - 1 N2 - INTRODUCTION: The occurrence rate of common peroneal nerve (CPN) palsy associated with knee dislocation or bicruciate ligament injury ranges from 10 to 40%. The present study sought first to describe the anatomic lesions encountered and their associated prognoses and second to recommend adequate treatment strategy based on a prospective multicenter observational series of knee ligament trauma cases. MATERIAL AND METHODS: Twelve out of 67 knees treated for dislocation or bicruciate lesion presented associated CPN palsy: two females, 10 males; mean age, 32 years. Four sports injuries,three traffic accidents and five other etiologies led to seven complete dislocations and five bicruciate ruptures. Four cases involved associated popliteal artery laceration ischemia; one of the dislocations was open. Paralysis was total in eight cases and partial in four. There were two complete ruptures, three contusions with CPN in continuity stretch lesions and three macroscopically normal aspects. RESULTS: At a minimum 1 year's follow-up, regardless of the initial surgical technique performed,recovery was complete in six cases, partial (in terms of motor function) in one and absent in five. Without specific CPN surgery, spontaneous recovery was partial in one case, complete in two and absent in none. Following simple emergency or secondary neurolysis, remission was total in four cases and absent in one. Three nerve grafts were all associated with non-recovery. DISCUSSION: The present results agree with literature findings. Palsy rates varied with trauma circumstances and departmental recruitment. Neurologic impairment was commensurate to ligamentary damages. The anatomic status of the CPN, subjected to violent traction by dislocation,was the most significant prognostic factor for neurologic recovery. In about 25% of dislocations, contusion-elongation over several centimeters was associated with as poor a prognosis as total rupture. CPN neurolysis is recommended when early clinical and EMG recovery fails to progress and/or in case of lateral ligamentary reconstruction. Possible peripheral nerve impairment needs to be included in the overall functional assessment of treatment for severe ligaments injuries and knee dislocation. LEVEL OF EVIDENCE: Level IV, prospective study. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/20170859/Common_peroneal_nerve_palsy_complicating_knee_dislocation_and_bicruciate_ligaments_tears_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0517(09)00429-8 DB - PRIME DP - Unbound Medicine ER -