A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg
After successful applications of the ultra-minimally invasive thread transecting technique (Guo Technique) for both thread carpal tunnel release and thread trigger finger release, we hypothesized that this technique could be used for superficial peroneal nerve release in the lower leg by selective crural fasciectomy. This study is aimed at testing the operative feasibility of performing the thread superficial peroneal nerve release (TSPNR) procedure in cadavers.
The TSPNR procedure was performed on 15 fresh frozen cadaveric lower-extremity specimens under ultrasound guidance. All cadaveric specimens were dissected and visually assessed immediately after the procedures.
All 15 legs demonstrated a complete transection of the crural fasciae along the course of the superficial peroneal nerve (SPN) including where it penetrated and traversed the crural fascia. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 20 min.
This cadaveric study demonstrated that the technique of TSPNR was accurate, reliable, and feasible while causing no injury to adjacent neurovascular structures and avoiding having to make a skin incision. Further studies are warranted to verify the results of this study before implementing this new technique in the clinical setting.
KeywordsSuperficial peroneal nerve entrapment release Leg pain Thread transecting procedure Ultrasound-guidance Ultra-minimally invasive procedure Guo technique
Thread superficial peroneal nerve release
Superficial peroneal nerve
Thread carpal tunnel release
Thread trigger finger release
The authors would like to thank Dennis Dykstra, M.D., Ph.D. for his ongoing support.
Compliance with ethical standards
Conflict of interest
Two of the authors, Danzhu Guo and Danqing Guo, are brothers to Joseph Guo who is the inventor of the Loop & Sheer thread. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The arrow indicates the superficial peroneal nerve as it courses distally piercing through the crural fascia, and the moving white dots above the superficial peroneal nerve are the thread looping the crural fascia (MP4 7976 kb)
- 1.Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A (2016) Ultrasound-guided fasciotomy for anterior chronic exertional compartment syndrome of the leg. J Ultrasound Med Off J Am Inst Ultrasound Med 35(4):823–829Google Scholar
- 6.Grant TH, Omar IM, Dumanian GA, Pomeranz CB, Lewis VA (2015) Sonographic evaluation of common peroneal neuropathy in patients with foot drop. J Ultrasound Med Off J Am Inst Ultrasound Med 34(4):705–711Google Scholar
- 12.Henry AK (1973) Extensile exposure, Second edn. Churchill LivingstoneGoogle Scholar
- 13.Kopell H, Thompson W (1963) Entrapment neuropathies. Williams & Wilkins, Baltimore, MarylandGoogle Scholar
- 17.Mackinnon SE (2018) Superficial peroneal nerve release in the lower leg - extended. In: WUSTL learn surg. https://www.youtube.com/watch?v=OGBWww538oY
- 19.Marques Mansano A, Trescot A (2016) The role of peripheral nerve injections in the diagnosis and treatment of CRPS. Phys Med Rehabil Res. https://doi.org/10.15761/PMRR.1000121
- 20.Peer S, Kovacs P, Harpf C, Bodner G (2002) High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J ultrasound Med Off J Am Inst Ultrasound Med 21(3):315–322Google Scholar
- 22.Rosson GD, Dellon AL (2005) Superficial peroneal nerve anatomic variability changes surgical technique. Clin Orthop (438):248–252Google Scholar
- 23.Saragaglia D, Farizon F, Drevet JG, Butel J (1986) Peroneal nerve entrapment syndrome of the front of the foot. Treatment by neurolysis. Apropos of a bilateral case. Rev Chir Orthop Reparatrice Appar Mot 72(8):579–581Google Scholar