Management and results of peroneal nerve lesions

OBJECTIVE: A retrospective analysis of clinical results in a relatively large series of peroneal nerve lesion is presented. Historically, such lesions have been difficult to manage successfully. METHODS: Between 1967 and 1991, 302 patients with either injury or tumor of the peroneal nerve at the knee were evaluated at Louisiana State University Medical Center. Mechanisms of injury included stretch injury with or without fracture ''sharp'' or ''blunt'' laceration, gunshot wound, compression, entrapment, and iatrogenic injury. Surgery was performed on 183 of 276 patients (66%). If spontaneous recovery had not occurred 4 to 6 months after injury, patients were operated on and lesions in continuity were usually evaluated using nerve action potential recordings. RESULTS: Eighty-six patients required interfascicular grafts. Graft lengths varied from 4 to 20 cm (average, 10 cm). Grafts measured <5.5 cm in some patients with blunt laceration, gunshot wound, or iatrogenic injury. Eighteen of 24 of those patients (75%) recovered peroneal function to Grade 3 or better, and a kickup foot brace was no longer needed to walk with a reasonable gait. Fourteen of 40 patients (35%) with graft lengths of 6 to 12 cm and only 3 of 22 patients (14%) with graft lengths of 13 to 20 cm recovered function to Grade 3 or better. Seventeen patients received end-to-end suture repair, and 14 (82%) recovered to Grade 3 or better by 24 months. After neurolysis, 71 of 80 patients (89%) with transmittable nerve action potentials across lesions in continuity recovered useful function despite severe preoperative functional loss in most cases. In addition, 24 tumors intrinsic to the peroneal nerve and two lesions caused by hypertrophic neuropathy were resected. CONCLUSION: Neural repair is the first priority in selected patients with peroneal nerve palsy. As with other nerve lesions, a timely operation and thorough intraoperative evaluation are necessary for optimal results.