Yadav Umesh, Nemani Mudit, Devgun Ashish, Malik Manmeet, Agrawal Gaurav K
Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND.
Orthopaedics and Trauma, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND.
Cureus. 2022 Jun 30;14(6):e26476. doi: 10.7759/cureus.26476. eCollection 2022 Jun.
Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel's sign was noted on follow-up. The patient finally recovered after a 3-month follow-up.
使用自体移植物重建前交叉韧带是现代常见的手术。腓骨长肌腱是一种新兴的移植物，相对于传统自体移植物有诸多优势。就踝关节的生物力学特性而言，其供区并发症极少。在获取腓骨长肌腱时，腓总神经损伤是理论上需要关注的问题。以下病例突出了在处理此类并发症时，谨慎的手术技术和及时干预的重要性。一名25岁男性在摔跤时前交叉韧带断裂。他的膝关节不稳定，日常生活活动困难。他接受了关节镜下使用腓骨长肌腱自体移植物重建前交叉韧带的手术。手术后，患者报告出现足下垂，足背感觉减退。患者被告知使用足下垂支具并服用神经保护药物。由于神经生理学研究在损伤后第一周无法区分部分和完全神经损伤，所以未进行此项检查。对神经进行了手术探查。发现神经内血肿，腓骨长肌腱有挫伤。进行了神经松解术以减压神经。随访期间前交叉韧带功能良好。随访时发现Tinel征进展。患者在3个月的随访后最终康复。
