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J Reconstr Microsurg 2019; 35(01): 057-065
DOI: 10.1055/s-0038-1667047
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis

Linden K. Head
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Katie Hicks
2   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
Gerald Wolff
3   Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
Kirsty U. Boyd
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
› Author Affiliations
Further Information

Publication History

27 February 2018

22 May 2018

Publication Date:
22 August 2018 (online)

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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

Presentation

This study was presented at the American Society of Peripheral Nerve (ASPN) Annual Meeting, January 12–14, 2018, in Phoenix, Arizona, United States.


Institutional Review Board (IRB) Approval

This study exclusively uses published data and is exempt from Institutional Review Board approval under the Tri-Council Policy Statement: Ethical Conduct of Research Involving Humans, 2nd edition (TCPS 2).


Study Registration

Review methodology was registered with PROSPERO (CRD42017067513), an international prospective register of systematic reviews.


 

  • References

  • 1 Nath RK, Lyons AB, Paizi M. Successful management of foot drop by nerve transfers to the deep peroneal nerve. J Reconstr Microsurg 2008; 24 (06) 419-427
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Giuffre JL, Bishop AT, Spinner RJ, Levy BA, Shin AY. Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma. Clin Orthop Relat Res 2012; 470 (03) 779-790
    CrossrefPubMedSearch in Google Scholar
  • 3 Wilkinson MC, Birch R. Repair of the common peroneal nerve. J Bone Joint Surg Br 1995; 77 (03) 501-503
    PubMedSearch in Google Scholar
  • 4 Bodily KD, Spinner RJ, Bishop AT. Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study. Clin Anat 2004; 17 (03) 201-205
    CrossrefPubMedSearch in Google Scholar
  • 5 Sedel L, Nizard RS. Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases. J Bone Joint Surg Br 1993; 75 (05) 772-774
    PubMedSearch in Google Scholar
  • 6 Prahinski JR, McHale KA, Temple HT, Jackson JP. Bridle transfer for paresis of the anterior and lateral compartment musculature. Foot Ankle Int 1996; 17 (10) 615-619
    CrossrefPubMedSearch in Google Scholar
  • 7 Medical Research Council Nerve Injuries Committee. Aids to the Investigation of Peripheral Nerve Injuries. London, UK: His Majesty's Stationery Office; 1942
    Search in Google Scholar
  • 8 George SC, Boyce DE. An evidence-based structured review to assess the results of common peroneal nerve repair. Plast Reconstr Surg 2014; 134 (02) 302e-311e
    CrossrefPubMedSearch in Google Scholar
  • 9 Johnson JE, Paxton ES, Lippe J. , et al. Outcomes of the Bridle procedure for the treatment of foot drop. Foot Ankle Int 2015; 36 (11) 1287-1296
    CrossrefPubMedSearch in Google Scholar
  • 10 Vertullo CJ, Nunley JA. Acquired flatfoot deformity following posterior tibial tendon transfer for peroneal nerve injury: a case report. J Bone Joint Surg Am 2002; 84-A (07) 1214-1217
    PubMedSearch in Google Scholar
  • 11 Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg 2008; 12 (01) 20-33
    CrossrefPubMedSearch in Google Scholar
  • 12 Nath RK, Mackinnon SE. Nerve transfers in the upper extremity. Hand Clin 2000; 16 (01) 131-139 , ix
    PubMedSearch in Google Scholar
  • 13 Gousheh J, Babaei A. A new surgical technique for the treatment of high common peroneal nerve palsy. Plast Reconstr Surg 2002; 109 (03) 994-998
    CrossrefPubMedSearch in Google Scholar
  • 14 Strazar R, White CP, Bain J. Foot reanimation via nerve transfer to the peroneal nerve using the nerve branch to the lateral gastrocnemius: case report. J Plast Reconstr Aesthet Surg 2011; 64 (10) 1380-1382
    CrossrefPubMedSearch in Google Scholar
  • 15 Flores LP, Martins RS, Siqueira MG. Clinical results of transferring a motor branch of the tibial nerve to the deep peroneal nerve for treatment of foot drop. Neurosurgery 2013; 73 (04) 609-615 , discussion 615–616
    CrossrefPubMedSearch in Google Scholar
  • 16 Leclère FM, Badur N, Mathys L, Vögelin E. Nerve transfers for persistent traumatic peroneal nerve palsy: the Inselspital Bern experience. Neurosurgery 2015; 77 (04) 572-579 , discussion 579–580
    CrossrefPubMedSearch in Google Scholar
  • 17 Ratanshi I, Clark TA, Giuffre JL. Immediate nerve transfer for the treatment of peroneal nerve palsy secondary to an intraneural ganglion: case report and review. Plast Surg (Oakv) 2017; 25 (01) 54-58
    CrossrefPubMedSearch in Google Scholar
  • 18 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedSearch in Google Scholar
  • 19 Higgins J, Green S. , eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5: The Cochrane Collaboration; 2011 . Available at: http://www.cochrane-handbook.org/ . Accessed September 9, 2017
    PubMedSearch in Google Scholar
  • 20 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25 (09) 603-605
    CrossrefPubMedSearch in Google Scholar
  • 21 Duggal A, Perez P, Golan E, Tremblay L, Sinuff T. Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review. Crit Care 2013; 17 (04) R142
    CrossrefPubMedSearch in Google Scholar
  • 22 Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg Am 2015; 40 (03) 546-53.e8
    CrossrefPubMedSearch in Google Scholar
  • 23 Guyatt G, Oxman AD, Akl EA. , et al. GRADE guidelines: 1. Introduction--GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64 (04) 383-394
    CrossrefPubMedSearch in Google Scholar
  • 24 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
    CrossrefPubMedSearch in Google Scholar
  • 25 Giuffre JL, Bishop AT, Spinner RJ, Shin AY. Surgical technique of a partial tibial nerve transfer to the tibialis anterior motor branch for the treatment of peroneal nerve injury. Ann Plast Surg 2012; 69 (01) 48-53
    CrossrefPubMedSearch in Google Scholar
  • 26 Flores LP. Proximal motor branches from the tibial nerve as direct donors to restore function of the deep fibular nerve for treatment of high sciatic nerve injuries: a cadaveric feasibility study. Neurosurgery 2009; 65 (6, Suppl): 218-224 , discussion 224–225
    CrossrefPubMedSearch in Google Scholar
  • 27 Büyükmumcu M, Ustün ME, Şeker M, Kocaoğullari Y, Sağmanligil A. The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve: an anatomical approach. J Anat 1999; 194 (Pt 2): 309-312
    CrossrefPubMedSearch in Google Scholar
  • 28 White CP, Cooper MJ, Bain JR, Levis CM. Axon counts of potential nerve transfer donors for peroneal nerve reconstruction. Can J Plast Surg 2012; 20 (01) 24-27
    CrossrefPubMedSearch in Google Scholar
  • 29 Pirela-Cruz MA, Hansen U, Terreros DA, Rossum A, West P. Interosseous nerve transfers for tibialis anterior muscle paralysis (foot drop): a human cadaver-based feasibility study. J Reconstr Microsurg 2009; 25 (03) 203-211
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Larkin LM, Kuzon Jr WM, Supiano MA, Galecki A, Halter JB. Effect of age and neurovascular grafting on the mechanical function of medial gastrocnemius muscles of Fischer 344 rats. J Gerontol A Biol Sci Med Sci 1998; 53 (04) B252-B258
    PubMedSearch in Google Scholar
  • 31 Lien SC, Cederna PS, Kuzon Jr WM. Optimizing skeletal muscle reinnervation with nerve transfer. Hand Clin 2008; 24 (04) 445-454 , vii
    CrossrefPubMedSearch in Google Scholar
  • 32 Borisov AB, Carlson BM. Cell death in denervated skeletal muscle is distinct from classical apoptosis. Anat Rec 2000; 258 (03) 305-318
    CrossrefPubMedSearch in Google Scholar
  • 33 Ferrante MA. Electrodiagnostic assessment of the brachial plexus. Neurol Clin 2012; 30 (02) 551-580
    CrossrefPubMedSearch in Google Scholar