Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study.

An anatomical cadaver study was carried out on 13 human cadavers to disclose the close anatomical relationship between the peroneal nerve and the surgical area of the high tibial osteotomy techniques. The common peroneal nerve passes within 3 to 6 mm. of the posterior aspect of the fibular head and neck and divides into its superficial and deep branches, 22 to 28 mm. distal to the fibular apex. Generally the extensor hallucis longus (EHL) muscle is innervated by one of the motor branches of the deep peroneal nerve which is anatomically located 74 to 82 mm. distal to the fibular apex. To avoid neurological complications with a high tibial osteotomy, fibular osteotomy should be carried out at the junction of the middle and distal thirds of the fibula without excessive medial and anterior displacement of fragments; a small fibular segment should be resected in knees which have a severe deformity and need a significant angle correction.