Korean J Sports Med.  2018 Mar;36(1):45-48. 10.5763/kjsm.2018.36.1.45.

Common Peroneal Nerve Palsy Associated with Multiple Knee Ligament Injury

• Ra HJ
• Lee KW
• Cho HK
• Ho BC
• Seo DK
• Choi YJ

• KMID: 2465228
• DOI: http://doi.org/10.5763/kjsm.2018.36.1.45

Abstract

Common peroneal nerve (CPN) injury associated with multiple-ligament knee injury is relatively rare. A 38-year-old male presented with left knee pain occurred during ssireum (Korean wrestling). The patient exhibited positive Lachman, grade 3 varus stress, and also positive dial testing at 30°. Sensory loss of some area of left foot and foot drop were observed. Magnetic resonance imaging showed complete anterior cruciate ligament (ACL) rupture and posterolateral corner (PLC) injury. Motor nerve conduction velocity indicated left CPN palsy. ACL and PLC reconstructions were performed 10 days after injury and nerve exploration was done simultaneously. Neurolysis and primary repair were also performed. At 26 months after injury, muscle power of the tibialis anterior and extensor hallucis longus improved to grade 3, and sensation in CPN area recovered to about 60%. There was good stability in injured knee. To the best of our knowledge, this is the first case report describing CPN palsy with multiple-ligament knee injury during ssireum.

Keyword

Common peroneal nerve; Knee; Ligament injury; Nerve palsy; Posterolateral corner

MeSH Terms

Adult
Anterior Cruciate Ligament
Foot
Humans
Knee Injuries
Knee*
Ligaments*
Magnetic Resonance Imaging
Male
Neural Conduction
Paralysis*
Peroneal Nerve*
Rupture
Sensation

Figure

• 

  Fig. 1 Magnetic resonance imaging. (A) Proton density (PD) fat suppression sagittal image shows the complete rupture of anterior cruciate ligament (arrow heads). (B) PD fat suppression coronal image shows the lateral collateral ligament rupture at femoral attachment site (arrow). (C) PD fat suppression coronal image shows the popliteus tendon rupture at femoral attachment site (arrow).

• 

  Fig. 2 There was evidence of contusion and incomplete rupture of common peroneal nerve, and the patient underwent neurolysis and primary repair (arrow heads).

Reference

1. Mook WR, Ligh CA, Moorman CT 3rd, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg. 2013; 21:343–354.

2. Oshima T, Nakase J, Numata H, Takata Y, Tsuchiya H. Common peroneal nerve palsy with multiple-ligament knee injury and distal avulsion of the biceps femoris tendon. Case Rep Orthop. 2015; 2015:306260.

3. Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005; 87:664–667.

4. Bottomley N, Williams A, Birch R, Noorani A, Lewis A, Lavelle J. Displacement of the common peroneal nerve in posterolateral corner injuries of the knee. J Bone Joint Surg Br. 2005; 87:1225–1226.

5. Cho D, Saetia K, Lee S, Kline DG, Kim DH. Peroneal nerve injury associated with sports-related knee injury. Neurosurg Focus. 2011; 31:E11.

6. Demuynck M, Zuker RM. The peroneal nerve: is repair worthwhile. J Reconstr Microsurg. 1987; 3:193–199.

7. Seidel JA, Koenig R, Antoniadis G, Richter HP, Kretschmer T. Surgical treatment of traumatic peroneal nerve lesions. Neurosurgery. 2008; 62:664–673.

8. Thoma A, Fawcett S, Ginty M, Veltri K. Decompression of the common peroneal nerve: experience with 20 consecutive cases. Plast Reconstr Surg. 2001; 107:1183–1189.

9. Kim DH, Murovic JA, Tiel RL, Kline DG. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery. 2004; 54:1421–1428.

10. Yeap JS, Birch R, Singh D. Long-term results of tibialis posterior tendon transfer for drop-foot. Int Orthop. 2001; 25:114–118.