Management outcome of peroneal nerve injury at knee level: experience of a single military institution.

ABSTRACT

BACKGROUND AND PURPOSE: We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. MATERIAL AND METHODS: Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). RESULTS: Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. CONCLUSIONS: Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short 'lazy S-shaped incision' around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.