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Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears - 11/02/10

Doi : 10.1016/j.otsr.2009.12.001 
P. Bonnevialle a, , F. Dubrana b, B. Galaud c, S. Lustig d, O. Barbier e, P. Neyret d, P. Rosset f, D. Saragaglia g

the French Society of Orthopedic and Traumatologic Surgery (SOFCOT)h

a Locomotor System Institute, Toulouse Teaching Hospital, Purpan Traumatology and Orthopedics Department, place du Dr Baylac, 31052 Toulouse cedex, France 
b Orthopedics Department, Cavale Blanche Teaching Hospital, 29200 Brest, France 
c Orthopedics-Traumatology Department, Caen Teaching Hospital, Côte de Nacre, 14033 Caen cedex, France 
d Albert Trillat Center, North Hospital Group, 8, rue de Margnolles, 69904 Lyon, France 
e Orthopedic and Traumatologic Surgery Department, Bégin Military Teaching Hospital, 69, avenue de Paris, 94160 Saint Mandé, France 
f Orthopedic Surgery Deparment 2, Trousseau Teaching Hospital, 37044 Tours cedex, France 
g Orthopedic and Sports Traumatology Surgery Department, Grenoble Teaching Hospital, Hôpital Sud, 38130 Échirolles, France 
h 56, rue Boissonade, 75014 Paris, France 

Corresponding author.

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Summary

Introduction

The occurrence rate of common peroneal nerve (CPN) palsy associated with knee dislocation or bicruciate ligament injury ranges from 10 to 40%. The present study sought first to describe the anatomic lesions encountered and their associated prognoses and second to recommend adequate treatment strategy based on a prospective multicenter observational series of knee ligament trauma cases.

Material and methods

Twelve out of 67 knees treated for dislocation or bicruciate lesion presented associated CPN palsy: two females, 10 males; mean age, 32 years. Four sports injuries, three traffic accidents and five other etiologies led to seven complete dislocations and five bicruciate ruptures. Four cases involved associated popliteal artery laceration ischemia; one of the dislocations was open. Paralysis was total in eight cases and partial in four. There were two complete ruptures, three contusions with CPN in continuity stretch lesions and three macroscopically normal aspects.

Results

At a minimum 1 year’s follow-up, regardless of the initial surgical technique performed, recovery was complete in six cases, partial (in terms of motor function) in one and absent in five. Without specific CPN surgery, spontaneous recovery was partial in one case, complete in two and absent in none. Following simple emergency or secondary neurolysis, remission was total in four cases and absent in one. Three nerve grafts were all associated with non-recovery.

Discussion

The present results agree with literature findings. Palsy rates varied with trauma circumstances and departmental recruitment. Neurologic impairment was commensurate to ligamentary damages. The anatomic status of the CPN, subjected to violent traction by dislocation, was the most significant prognostic factor for neurologic recovery. In about 25% of dislocations, contusion-elongation over several centimeters was associated with as poor a prognosis as total rupture. CPN neurolysis is recommended when early clinical and EMG recovery fails to progress and/or in case of lateral ligamentary reconstruction. Possible peripheral nerve impairment needs to be included in the overall functional assessment of treatment for severe ligaments injuries and knee dislocation.

Level of evidence

Level IV, prospective study.

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Keywords : Common peroneal nerve palsy, Traumatic knee dislocation, Bicruciate ligament injuries


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Vol 96 - N° 1

P. 64-69 - février 2010 Retour au numéro
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