Abstract
Background Given the unsatisfactory outcomes with traditional treatments, there is growing interest
in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The
objective of this work was to perform a systematic review and meta-analysis of the
primary literature to assess the effectiveness of nerve transfer surgery in restoring
ankle dorsiflexion in patients with peroneal nerve palsy.
Methods Methodology was registered with PROSPERO, and PRISMA guidelines were followed. MEDLINE,
EMBASE, and the Cochrane Library were systematically searched. English studies investigating
outcomes of nerve transfers in peroneal nerve palsy were included. Two reviewers completed
screening and extraction. Methodological quality was evaluated with Newcastle-Ottawa
Scale.
Results Literature search identified 108 unique articles. Following screening, 14 full-text
articles were reviewed. Four retrospective case series met inclusion criteria for
meta-analysis. Overall, 41 patients underwent nerve transfer for peroneal nerve palsy.
The mean age of the patients was 36.1 years, mean time to surgery was 6.3 months,
and the mean follow-up period was 19.0 months. Donor nerve was either tibial (n = 36) or superficial peroneal branches/fascicles (n = 5). Recipient nerve was either deep peroneal (n = 24) or tibialis anterior branch (n = 17). Postoperative ankle dorsiflexion strength demonstrated a bimodal distribution
with a mean Medical Research Council of 2.1. There were no significant differences
in dorsiflexion strength between injury sites (p = 0.491), injury mechanisms (p = 0.125), donor (p = 0.066), or recipient nerves (p = 0.496). There were no significant correlations between dorsiflexion strength and
patient age (p = 0.094) or time to surgery (p = 0.493).
Conclusions There is variability in dorsiflexion strength following nerve transfer in peroneal
nerve palsy, whereby there appear to be responders and non-responders. Further studies
are needed to better define appropriate patient selection and the role of nerve transfers
in the management of peroneal nerve palsy.
Keywords
peripheral nerve - nerve transfer - peroneal nerve palsy
