ABSTRACT
PURPOSE: The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. METHODS: Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. RESULTS: The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41). CONCLUSION: Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.
Subject(s)
Anterior Cruciate Ligament , Collateral Ligaments , Humans , Anterior Cruciate Ligament/surgery , Peroneal Nerve/surgery , Peroneal Nerve/anatomy & histology , Femur/surgery , Cadaver , Knee Joint/surgeryABSTRACT
Se describe el caso clínico de un paciente de 34 años de edad, con antecedente de salud, atendido en la consulta intermunicipal de II Frente, provincia de Santiago de Cuba, por presentar, desde hacía 8 meses, una lesión en el nervio peroneo común, en la cara lateral del tercio superior de la pierna derecha, a causa de una mordida de cerdo, la cual no fue diagnosticada inicialmente, sino que se trató como una herida sin lesión neurológica. Se realizó proceder quirúrgico, consistente en una transposición tendinosa del músculo tibial posterior. Se inmovilizó el pie con una férula de yeso por 15 días, se le retiró la sutura a las 6 semanas y se indicó rehabilitación. A las 12 semanas comenzó a caminar sin dificultad y logró reincorporarse a sus actividades cotidianas.
The case report of a 34 years patient with health history is described. He was assisted in the intermunicipal visit of II Frente, province of Santiago de Cuba, due to a lesion in the common peroneal nerve during 8 months, in the lateral face of the superior third of the right leg, because of a pig bite, which was not diagnosed initially, but instead it was treated as a wound without neurological lesion. A surgical procedure was carried out, with a tendon transposition of the posterior tibial muscle. The foot was immobilized with a plaster splint for 15 days, the suture was removed 6 weeks later and rehabilitation was indicated. Twelve weeks later he began to walk without difficulty and he was able to return to his daily activities.
Subject(s)
Surgical Procedures, Operative , Tendon Transfer , FootABSTRACT
A popliteal nerve block may be used to provide anesthesia and extended analgesia of the lower extremity, to ameliorate severe and long lasting postoperative pain. The aim of this study was to elucidate the anatomical location of tibial (TN) and common peroneal (CPN) nerves in the popliteal crease for effective nerve block. Fifty fresh specimens from 27 adult Chinese cadavers (16 males and 11 females, age range from 35 to 87 years) were investigated. Twenty-two cadavers were used to identify nerve locations and 5 cadavers were used to determine the depths of nerves in cross section. TN was found to be located at 50% from the most lateral point of the popliteal crease at 1.4 cm deep to the surface. In 20% of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26.0% from the most lateral point of the popliteal crease and at 0.7 cm deep to the surface. Furthermore, in 6.0% of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. This study suggests that the TN and CPN leave the sciatic nerve at variable distances from the popliteal crease. However, we believe that the results of the present study about the location of TN and CPN at the popliteal crease offer a good guide to optimal nerve block.
El bloqueo nervioso poplíteo puede ser utilizado para proporcionar anestesia y analgesia prolongada del miembro inferior y para aliviar el dolor postoperatorio severo y duradero. El objetivo fue determinar la localización anatómica de los nervios tibial (NT) y fibular común (NFC) en el pliegue poplíteo para un bloqueo nervioso efectivo. Se utilizaron 50 miembros inferiores frescos pertenecientes a 27 cadáveres adultos chinos (16 hombres y 11 mujeres, rango de edad entre 35-87 años). Se utilizaron 22 cadáveres para identificar la localización de los nervios y los 5 restantes para determinar la profundidad de los nervios en una sección transversal. El NT se encontró en el 50% de los casos desde el punto más lateral del pliegue poplíteo a 1,4 cm de la superficie. En el 20% de 50 muestras, el nervio cutáneo sural medial se ramificó por debajo o en el pliegue poplíteo, mientras que el NFC se encontró en el 26% de los casos desde el punto más lateral del pliegue poplíteo a 0,7 cm de la superficie. Además, en el 6% de las muestras, el nervio cutáneo sural lateral se ramificó por debajo o en el pliegue poplíteo. Nuestros resultados sugieren que el NT y NFC emergen del nervio ciático a distancias variables del pliegue poplíteo. Creemos que los resultados sobre la ubicación de NT y NFC en el pliegue poplíteo ofrecen una buena guía para el adecuado bloqueo nervioso.