J Knee Surg 2019; 32(06): 560-564
DOI: 10.1055/s-0038-1660512
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

John R. Worley
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Olubusola Brimmo
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Clayton W. Nuelle
2   TSAOG Orthopaedics, Burkhart Research Institute for Orthopaedics, San Antonio, Texas
,
James L. Cook
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
3   Thompson Laboratory for Regenerative Orthopaedics, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
James P. Stannard
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
3   Thompson Laboratory for Regenerative Orthopaedics, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
› Author Affiliations
Funding None.
Further Information

Publication History

05 April 2018

30 April 2018

Publication Date:
13 June 2018 (online)

Abstract

The purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0–117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty (p = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity (p = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; p = 0.17), Lysholm score (mean 88.6 vs. 88.8; p = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; p = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower (p = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity.

Note

This study was approved by our university's Institutional Review Board.


 
  • References

  • 1 Woodmass JM, Romatowski NP, Esposito JG, Mohtadi NG, Longino PD. A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2992-3002
  • 2 Thomsen PB, Rud B, Jensen UH. Stability and motion after traumatic dislocation of the knee. Acta Orthop Scand 1984; 55 (03) 278-283
  • 3 Ríos A, Villa A, Fahandezh H, de José C, Vaquero J. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma 2003; 55 (03) 489-494
  • 4 Tay AK, MacDonald PB. Complications associated with treatment of multiple ligament injured (dislocated) knee. Sports Med Arthrosc Rev 2011; 19 (02) 153-161
  • 5 Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma 2007; 21 (02) 92-96
  • 6 LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med 1997; 25 (04) 433-438
  • 7 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 (03) 198-202
  • 8 Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008; 21 (04) 261-268
  • 9 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 (05) 664-667
  • 10 Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. Am J Roentgenol 2009; 192 (01) 101-106
  • 11 Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop Relat Res 2012; 470 (03) 774-778
  • 12 Levy BA, Dajani KA, Whelan DB. , et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25 (04) 430-438
  • 13 Molund M, Engebretsen L, Hvaal K, Hellesnes J, Ellingsen Husebye E. Posterior tibial tendon transfer improves function for foot drop after knee dislocation. Clin Orthop Relat Res 2014; 472 (09) 2637-2643
  • 14 Cook S, Ridley TJ, McCarthy MA. , et al. Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2983-2991
  • 15 Bonnevialle P, Dubrana F, Galau B. , et al; 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 (01) 64-69
  • 16 Montgomery TJ, Savoie FH, White JL, Roberts TS, Hughes JL. Orthopedic management of knee dislocations. Comparison of surgical reconstruction and immobilization. Am J Knee Surg 1995; 8 (03) 97-103
  • 17 Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985; (198) 94-101
  • 18 Cush G, Irgit K. Drop foot after knee dislocation: evaluation and treatment. Sports Med Arthrosc Rev 2011; 19 (02) 139-146
  • 19 Boyce RH, Singh K, Obremskey WT. Acute management of traumatic knee dislocations for the generalist. J Am Acad Orthop Surg 2015; 23 (12) 761-768
  • 20 Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14 (03) 187-196
  • 21 Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A. Surgical treatment of multiple knee ligament injuries in 44 patients: 2-8 years follow-up results. Knee Surg Sports Traumatol Arthrosc 2006; 14 (08) 739-749
  • 22 Liow RY, McNicholas MJ, Keating JF, Nutton RW. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 2003; 85 (06) 845-851
  • 23 Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A (02) 262-273
  • 24 Fanelli GC, Sousa PL, Edson CJ. Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common. Clin Orthop Relat Res 2014; 472 (09) 2712-2717
  • 25 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 (05) 718-727
  • 26 O'Toole RV, Castillo RC, Pollak AN, MacKenzie EJ, Bosse MJ. ; LEAP Study Group. Determinants of patient satisfaction after severe lower-extremity injuries. J Bone Joint Surg Am 2008; 90 (06) 1206-1211
  • 27 Magit D, Wolff A, Sutton K, Medvecky MJ. Arthrofibrosis of the knee. J Am Acad Orthop Surg 2007; 15 (11) 682-694
  • 28 Krych AJ, Giuseffi SA, Kuzma SA, Stuart MJ, Levy BA. Is peroneal nerve injury associated with worse function after knee dislocation?. Clin Orthop Relat Res 2014; 472 (09) 2630-2636