Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA.
Foot Ankle Int. 2021 May;42(5):658-668. doi: 10.1177/1071100721995421. Epub 2021 Feb 25.
Dislocation of the native knee represents a challenging injury, further complicated by the high rate of concurrent injury to the common peroneal nerve (CPN). Initial management of this injury requires a thorough neurovascular examination, given the prevalence of popliteal artery injury and limb-threatening ischemia. Further management of a knee dislocation with associated CPN palsy requires coordinated care involving the sports surgeon for ligamentous knee reconstruction and the peripheral nerve surgeon for staged or concurrent peroneal nerve decompression and/or reconstruction. Finally, the foot and ankle surgeon is often required to manage a foot drop with a distal tendon transfer to restore foot dorsiflexion. For instance, the Bridle Procedure-a modification of the anterior transfer of the posterior tibialis muscle, under the extensor retinaculum, with tri-tendon anastomosis to the anterior tibial and peroneus longus tendons at the anterior ankle-can successfully return patients to brace-free ambulation and athletic function following CPN palsy. Cross-discipline coordination and collaboration is essential to ensure appropriate timing of operative interventions and ensure maintenance of passive dorsiflexion prior to tendon transfer.
膝关节脱位是一种具有挑战性的损伤，加上腓总神经（CPN）同时受伤的比例较高，情况更为复杂。鉴于腘动脉损伤和肢体威胁性缺血的高发率，这种损伤的初始治疗需要进行彻底的神经血管检查。对于膝关节脱位伴发 CPN 麻痹的进一步治疗，需要涉及运动外科医生进行韧带膝关节重建，以及周围神经外科医生进行分期或同期腓总神经减压和/或重建。最后，足部和踝关节外科医生通常需要通过远端肌腱转移来管理足下垂，以恢复足背屈。例如，Bridle 手术-一种改良的胫骨后肌前转移术，在伸肌支持带下进行，三腱吻合于前踝的胫骨前肌腱和腓骨长肌腱-可以成功地使 CPN 麻痹患者恢复无支架行走和运动功能。跨学科的协调与合作对于确保手术干预的时机适当以及在肌腱转移前保持被动背屈至关重要。
