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Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation

  • Symposium: Complex Knee Ligament Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Acute knee dislocation is rare but has a high rate of associated neurovascular injuries and potentially limb-threatening complications. These include the substantial morbidity associated with peroneal nerve injury: neuropathic pain, decreased mobility, and considerably reduced function, which not only impairs patient function but complicates treatment.

Questions/purposes

We therefore identified and quantified the risks associated with specific factors for peroneal nerve injury and recovery in patients with knee dislocations.

Patients and Methods

We retrospectively reviewed the charts of 26 patients, from among a cohort of all 91 knee dislocations, with a peroneal nerve palsy over a 5-year period. We then used univariable and multivariable statistics to identify risk factors predicting peroneal nerve injury and recovery.

Results

Gender (odds ratio, 5.47), body mass index (odds ratio, 1.14), and fibular head fracture (odds ratio, 4.77) were associated with peroneal nerve injury. Only younger age was associated with peroneal nerve recovery.

Conclusions

Knowledge of the risk factors for peroneal nerve injury and the predictors of recovery in knee dislocation allows the treating surgeon to have a better understanding of the nature of the neurologic injury and modify management based on the anticipated return of nerve function.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aigner F, Longato S, Gardetto A, Deibl M, Fritsch H, Piza-Katzer H. Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg. Clin Anat. 2004;17:503–512.

    Article  PubMed  CAS  Google Scholar 

  2. Bonnevialle P, Dubrana F, Galau B, Lustig S, Barbier O, Neyret P, Rosset P, Saragaglia D; la Société française de chirurgie orthopédique et traumatologique. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res. 2010;96:64–69.

    Article  PubMed  CAS  Google Scholar 

  3. Ciaramitaro P, Mondelli M, Logullo F, Grimaldi S, Battiston B, Sard A, Scarinzsi C, Migliaretti G, Faccani G, Cocito D; Italian Network for Traumatic Neuropathies. Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients. J Peripher Nerv Syst. 2010;15:120–127.

    Article  PubMed  Google Scholar 

  4. de Bruijn IL, Geertzen JH, Dijkstra PU. Functional outcome after peroneal nerve injury. Int J Rehabil Res. 2007;30:333–337.

    Article  PubMed  Google Scholar 

  5. Ferraresi S, Garozzo D, Buffatti P. Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer. Neurosurg Rev. 2003;26:175–179.

    PubMed  Google Scholar 

  6. Frassica FJ, Sim FH, Staeheli JW, Pairolero PC. Dislocation of the knee. Clin Orthop Relat Res. 1991;263:200–205.

    PubMed  Google Scholar 

  7. Garozzo D, Ferraresi S, Buffatti P. Surgical treatment of common peroneal nerve injuries: indications and results: a series of 62 cases. J Neurosurg Sci. 2004;48:105–112.

    PubMed  CAS  Google Scholar 

  8. Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ, Levy BA. Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2010;18:1583–1586.

    Article  PubMed  Google Scholar 

  9. Goitz RJ, Tomaino MM. Management of peroneal nerve injuries associated with knee dislocations. Am J Orthop (Belle Mead NJ). 2003;32:14–16.

    Google Scholar 

  10. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86:262–273.

    PubMed  Google Scholar 

  11. Kadiyala RK, Ramirez A, Taylor AE, Saltzman CL, Cassell MD. The blood supply of the common peroneal nerve in the popliteal fossa. J Bone Joint Surg Br. 2005;87:337–342.

    Article  PubMed  CAS  Google Scholar 

  12. Kovacic U, Sketelj J, Bajrović FF. Age-related differences in the reinnervation after peripheral nerve injury. Int Rev Neurobiol. 2009;87:465–482.

    Article  PubMed  CAS  Google Scholar 

  13. Kovacic U, Zele T, Mars T, Sketelj J, Bajrović FF. Aging impairs collateral sprouting of nociceptive axons in the rat. Neurobiol Aging. 2010;31:339–350.

    Article  PubMed  CAS  Google Scholar 

  14. Marin EL, Bifulco SS, Fast A. Obesity. A risk factor for knee dislocation. Am J Phys Med Rehabil. 1990;69:132–134.

    Article  PubMed  CAS  Google Scholar 

  15. Medical Research Council. Aids to the Examination of the Peripheral Nervous System. London, UK: Her Majesty’s Stationery Office; 1976.

  16. Medvecky MJ, Zazulak BT, Hewett TE. A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete. Sports Med. 2007;37:169–187.

    Article  PubMed  Google Scholar 

  17. Meyers MH, Harvey JP Jr. Traumatic dislocation of the knee joint: a study of eighteen cases. J Bone Joint Surg Am. 1971;53:16–29.

    PubMed  CAS  Google Scholar 

  18. Meyers MH, Moore TM, Harvey JP Jr. Traumatic dislocation of the knee joint. J Bone Joint Surg Am. 1975;57:430–433.

    PubMed  CAS  Google Scholar 

  19. Moore TM. Fracture-dislocation of the knee. Clin Orthop Relat Res. 1981;156:128–140.

    PubMed  Google Scholar 

  20. Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005;87:664–667.

    Article  PubMed  CAS  Google Scholar 

  21. Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol. 2009;192:101–106.

    Article  PubMed  Google Scholar 

  22. Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg. 2008;21:261–268.

    PubMed  Google Scholar 

  23. Prasad AR, Steck JK, Dellon AL. Zone of traction injury of the common peroneal nerve. Ann Plast Surg. 2007;59:302–306.

    Article  PubMed  CAS  Google Scholar 

  24. Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30:718–727.

    PubMed  Google Scholar 

  25. Schenck R. Classification of knee dislocations. Oper Tech Sports Med. 2003;11:193–198.

    Article  Google Scholar 

  26. Sisto DJ, Warren RF. Complete knee dislocation: a follow-up study of operative treatment. Clin Orthop Relat Res. 1985;198:94–101.

    PubMed  Google Scholar 

  27. Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma. 2003;17:198–202.

    Article  PubMed  Google Scholar 

  28. Vaughan DW. Effects of advancing age on peripheral nerve regeneration. J Comp Neurol. 1992;323:219–237.

    Article  PubMed  CAS  Google Scholar 

  29. Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11:525–529.

    Article  PubMed  CAS  Google Scholar 

  30. Werier J, Keating JF, Meek RN. Complete dislocation of the knee: the long term results of ligamentous reconstruction. Knee. 1998;5:255–260.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Toronto, St Michael’s Hospital, 55 Queen Street E, Suite 800, Toronto, ON, M5C 1R6, Canada

    Christopher J. Peskun MD, Jas Chahal MD, Zvi Y. Steinfeld BSc & Daniel B. Whelan MD

Authors
  1. Christopher J. Peskun MD
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  2. Jas Chahal MD
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  3. Zvi Y. Steinfeld BSc
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  4. Daniel B. Whelan MD
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Corresponding author

Correspondence to Daniel B. Whelan MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Peskun, C.J., Chahal, J., Steinfeld, Z.Y. et al. Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation. Clin Orthop Relat Res 470, 774–778 (2012). https://doi.org/10.1007/s11999-011-1981-0

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  • DOI: https://doi.org/10.1007/s11999-011-1981-0

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