scholarly journals Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Takeshi Oshima ◽  
Junsuke Nakase ◽  
Hitoaki Numata ◽  
Yasushi Takata ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Case Report ◽  
Peroneal Nerve ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Postoperative Management ◽  
Return To Sports ◽  
First Case ◽  
Biceps Femoris Tendon

A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.

scholarly journals Diagnóstico y tratamiento de la entesopatía distal del bíceps crural en un corredor profesional (Diagnosis and treatment of distal biceps femoris tendon enthesopathy in a professional runner)

2019 ◽  
Vol 0 (Avance Online) ◽  
Author(s):  
Antonio León Garrigosa
Keyword(s):  
Peroneal Nerve ◽  
Histological Study ◽  
Treatment Strategies ◽  
Biceps Femoris ◽  
Complete Recovery ◽  
Postoperative Management ◽  
Distal Biceps ◽  
Temporary Relief ◽  
El Sistema ◽  
Biceps Femoris Tendon

RESUMEN Objetivo: describir el diagnóstico y tratamiento de la entesopatía del tendón distal del bíceps crural en un corredor profesional. Método: el diagnóstico se obtuvo mediante datos clínicos y exploraciones complementarias. Describimos la técnica quirúrgica, el manejo post-operatorio y el sistema de valoración empleado en el seguimiento. Resultados: el diagnóstico se confirmó histológicamente. La recuperación funcional fue completa. Conclusión: solo hemos encontrado otro caso publicado de entesopatía del tendón distal del bíceps crural, sin referencia a afectación del nervio ciático poplíteo externo. Si el tratamiento conservador no resuelve la sintomatología, puede estar indicada la cirugía. ABSTRACT Objective: to describe the diagnostic and treatment strategies for distal biceps femoris tendon enthesopathy, in a professional runner. Method: The diagnosis was based on clinical and complementary studies. The surgical technique, postoperative management and assessment, are described. Results: Histological study confirmed the diagnosis and the clinical outcome was satisfactory, with complete recovery after surgical management. Conclusion: there is only one published study assessing distal biceps femoris tendon enthesopathy. The possible involvement of the peroneal nerve has not been previously considered. If conservative treatment only provides temporary relief of symptoms, then surgery can be indicated. RESUMO Objetivo: descrever o diagnóstico e tratamento da entesopatia do tendão crural do bíceps distal em um corredor profissional. Método: o diagnóstico foi obtido por meio de dados clínicos e explorações complementares. Descrevemos a técnica cirúrgica, o manejo pós-operatório e o sistema de avaliação utilizado no acompanhamento. Resultados: o diagnóstico foi confirmado histologicamente. A recuperação funcional foi completa. Conclusão: encontramos apenas outro caso publicado de entesopatia do tendão distal do bíceps crural, sem referência ao envolvimento do nervo ciático poplíteo externo. Se o tratamento conservador não resolver os sintomas, a cirurgia pode ser indicada.

scholarly journals Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Aki Fukuda ◽  
Akinobu Nishimura ◽  
Shigeto Nakazora ◽  
Ko Kato ◽  
Akihiro Sudo
Keyword(s):  
Peroneal Nerve ◽  
Surgical Repair ◽  
Tendon Repair ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Complete Removal ◽  
Distal Biceps ◽  
Surgical Suture ◽  
The Common ◽  
Biceps Femoris Tendon

We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neurolysis significantly improved the palsy. The common peroneal nerve is prone to damage as a result of its close proximity to the biceps femoris tendon and it should be identified during surgical repair of a ruptured distal biceps femoris tendon.

scholarly journals Risk factors for common peroneal nerve injury in knee dislocation: a retrospective study

2020 ◽  
Author(s):  
Lei Tan ◽  
junfeng wang ◽  
xinguang liu ◽  
xing xin ◽  
xiaohua wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Knee Dislocation ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Tendon Injury ◽  
Fibular Head ◽  
Popliteofibular Ligament ◽  
Injury Group ◽  
Biceps Femoris Tendon

Abstract Background Knee dislocation is a serious injury, representing less than 0.2% of all orthopedic injuries, and 16% to 40% of these patients suffer an associated injury to the common peroneal nerve (CPN). However, it is still unclear which structures are most intently associated with CPN injury. This study attempts to analyze the potential risk factors for CPN injury and provide clues for a comprehensive diagnosis of knee dislocation. Methods We retrospectively reviewed 153 cases of knee dislocation related to lateral and/or posterior ligament injury between 2015 and 2018. All 153 patients were divided into the CPN injury group or the no-CPN injury group. The baseline characteristics included age, gender, cause of injury, posterior cruciate ligament (PCL) disruption, anterior cruciate ligament (ACL) disruption, popliteofibular ligament and/or tendon of popliteus injury, biceps femoris tendon injury and fibular head fracture. We identified potential variables for a multivariable logistic regression model to identify the major risk factors for CPN injury. Results Multivariate regression analysis revealed the biceps femoris tendon injury and fibular head fracture to be predictive of CPN injury in knee dislocation. Gender, age, cause of injury, ligamentous classification, popliteofibular ligament and/or tendon of popliteus injury, PCL disruption or ACL disruption do not predict CPN injury. Conclusions Biceps femoris tendon injury and fibular head fracture are risk factors of CPN injury in knee dislocation. A better understanding of the risk factors for CPN injury allows surgeons to achieve more accurate diagnoses.

Iatrogenic common peroneal nerve injury during harvesting of semitendinosus tendon for anterior cruciate ligament reconstruction

2021 ◽  
Vol 14 (4) ◽  
pp. e240736
Author(s):  
Raf Mens ◽  
Albert van Houten ◽  
Roy Bernardus Gerardus Brokelman ◽  
Roy Hoogeslag
Keyword(s):  
Anterior Cruciate Ligament ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Peroneal Nerve Injury ◽  
The Common ◽  
Anterior Cruciate ◽  
Incision Technique

We present a case of iatrogenic injury to the common peroneal nerve (CPN) occurring due to harvesting of a hamstring graft, using a posterior mini-incision technique. A twitch of the foot was noted on retraction of the tendon stripper. After clinically diagnosing a CPN palsy proximal to the knee, the patient was referred to a neurosurgeon within 24 hours. An electromyography (EMG) was not obtained since it cannot accurately differentiate between partial and complete nerve injury in the first week after injury. Because the nerve might have been transacted by the tendon stripper, surgical exploration within 72 hours after injury was indicated. An intraneural haematoma was found and neurolysis was performed to decompress the nerve. Functioning of the anterior cruciate ligament was satisfactory during follow-up. Complete return of motor function of the CPN was observed at 1-year follow-up, with some remaining hypoaesthesia.

Anatomic Multiple Ligament Reconstructions of the Knee

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110392
Author(s):  
Edward R. Floyd ◽  
Gregory B. Carlson ◽  
Jill K. Monson ◽  
Robert F. LaPrade
Keyword(s):  
Range Of Motion ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Single Stage ◽  
Anatomic Reconstruction ◽  
Single Bundle ◽  
Ligament Injuries ◽  
Optimal Sequence

Background: Multiple ligament injuries of the knee occur in a variety of settings, often from athletic activities. Multiple cruciate and collateral ligament injuries may be associated with hamstring tendon rupture, common peroneal nerve (CPN) injury, meniscus, bone, and cartilage damage. Indications: After evaluation for concomitant life-threatening and vascular injuries (especially of the popliteal artery), the knee is assessed through a thorough physical examination and imaging series, including varus, valgus, and posterior stress radiography, and magnetic resonance imaging (MRI). Research over the last 30 years has suggested that operative treatment in the acute setting (<3 weeks) in a single-stage procedure may have improved results to delayed/staged reconstruction. Early range of motion starting on postoperative day 1 is important to prevent development of arthrofibrosis. Technique: We describe the technique used to surgically manage a patient suffering from anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and complete posterolateral corner (PLC) rupture. Neurolysis of the CPN is performed to free the irritated nerve from scar tissue, along with biceps femoris tendon and lateral capsular repairs. Anatomic-based reconstructions are performed. The ACL reconstruction is with a single bundle using a patellar tendon autograft, PCL reconstruction is a double bundle with Achilles and tibialis anterior tendon allografts, and PLC reconstruction is accomplished with a split Achilles tendon allograft. The correct orientation of tunnel placement must be planned to avoid tunnel convergence; these angles have been determined through 3D modeling. The optimal sequence for graft tensioning has been established and follows the pattern: PCL, ACL, PLC, and then medial-sided structures if necessary. Results: Successful outcomes have been reported for both medial and lateral based injuries, and follow-up studies have also shown equivalent results between acute and chronic outcomes, and for multiligament injuries involving the ACL and PCL if anatomic reconstructions with appropriate tunnel angles, passage and tensioning sequence of grafts, and rehabilitation regimens are performed. Discussion/Conclusion: Single-stage anatomic reconstruction is the gold standard for managing multiple ligament injuries in the knee. Commencement of early 0° to 90° knee range of motion and PCL-supporting bracing are critical to prevent arthrofibrosis and protect the grafts from attenuation.

scholarly journals Neurapraxia of the common peroneal nerve- a rare complication resulting from wearing a KBM prosthesis: A case report

1996 ◽  
Vol 20 (3) ◽  
pp. 197-198 ◽  
Author(s):  
M. F. Reinders ◽  
J. H. B. Geertzen ◽  
J. S. Rietman
Keyword(s):  
Case Report ◽  
Peroneal Nerve ◽  
Rare Complication ◽  
Common Peroneal Nerve ◽  
Lower Leg ◽  
Accurate Information ◽  
Traumatic Amputation ◽  
Clinical Note ◽  
Compression Neuropathy ◽  
The Common

This clinical note describes a 47-year-old man who had a traumatic amputation of the left lower leg. Two months after wearing a Kondylen Bettung Miinster (KMB) prosthesis, he developed a compression neuropathy of the common peroneal nerve of his right leg after sitting cross-legged. This troublesome complication can be avoided by giving accurate information to the patient.

Clipping of a Cerebral Aneurysm in a Patient With Loeys-Dietz Syndrome: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. E752-E755 ◽  
Author(s):  
Betsy D Hughes ◽  
Ciaran J Powers ◽  
Ali R Zomorodi
Keyword(s):  
Case Report ◽  
Cerebral Aneurysm ◽  
Vascular Reactivity ◽  
Artery Aneurysm ◽  
Postoperative Management ◽  
Vascular Involvement ◽  
Arnold Chiari Malformation ◽  
Lumbar Drain ◽  
First Case ◽  
Temporary Clipping

Abstract BACKGROUND AND IMPORTANCE: This is the first case report of clipping a cerebral aneurysm in a patient with Loeys-Dietz syndrome (LDS). LDS is a newly described autosomal dominant connective tissue disease with systemic vascular involvement. Unique to this syndrome is the development of aneurysms at a young age with the propensity of dissection or rupture at a stage that is earlier than when surgical intervention is typically indicated. We describe the nuances in intraoperative and postoperative management. CLINICAL PRESENTATION: A 31-year-old woman who recently received a diagnosis of with LDS type II presented to neurosurgical attention for management of an unruptured right ophthalmic artery aneurysm. The patient underwent a right pterional craniotomy for clipping of the aneurysm, with lumbar drain placement before the procedure. Papaverine had to be used several times to counteract vasospasm of the vessels during arachnoid dissection. Because of vascular reactivity, temporary clipping was not used, and the aneurysm was clipped successfully. CONCLUSION: LDS is a newly described disorder that warrants awareness in the neurosurgical community because of its association with intracerebral aneurysms as well as craniosynostosis (19%), scoliosis (20%), cervical spine instability (7%), hydrocephalus, and Arnold-Chiari malformation. When clipping aneurysms in these patients, the surgeon should be aware of the potential for severe vascular reactivity during dissection and avoid temporary clipping when possible. Avoidance of lumbar drainage intraoperatively reduces the risk of intracranial hypotension after removal.

scholarly journals Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature

2021 ◽  
Author(s):  
Mohammad Tahami ◽  
Arash Sharafat Vaziri ◽  
Mohammad Naghi Tahmasebi ◽  
Fardis Vosoughi ◽  
Majid Khalilizad ◽  
...  
Keyword(s):  
Case Report ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Full Range ◽  
The Body ◽  
Tibial Tubercle ◽  
Partial Weight Bearing ◽  
Rehabilitation Protocol ◽  
Partial Weight

Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures. Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up. Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.

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