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Clinical Outcomes of Nerve Transfers in Patients with Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis
Linden Kyle Head, MD, HBA, BSc, BPHE1; Katie Hicks, BSc2; Gerald Wolff, MD, FRCPC3; Kirsty Usher Boyd, MD, FRCSC1; (1)Division of Plastic Surgery, University of Ottawa, Ottawa, ON, Canada, (2)Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, (3)Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada

INTRODUCTION: Peroneal nerve palsy and its associated foot drop is typically managed with ankle-foot orthosis, autogenous nerve grafting, or tendon transfers. Nerve transfers have the potential to reestablish ankle dorsiflexion in this patient population. The objective of this study was to review the clinical outcomes of nerve transfers in patients with peroneal nerve palsy.

MATERIALS & METHODS: Review methodology was registered with PROSPERO and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A systematic search of MEDLINE, EMBASE, and The Cochrane Library was conducted. English studies were included that investigated the clinical outcomes of nerve transfers in patients with peroneal nerve palsy. Two independent reviewers performed screening and data extraction. Methodological quality was evaluated using the Newcastle-Ottawa Scale (NOS) for assessing non-randomized studies in meta-analyses. Meta-analysis of pooled data was performed using descriptive statistics, Kruskal-Wallis test, and Spearman's rho.

RESULTS: Systematic literature search identified 106 unique articles. Following screening, 12 full-text articles were reviewed and 4 met inclusion criteria for data extraction, qualitative synthesis, and meta-analysis. All included studies were retrospective case series with a mean NOS score of 5.0/6.0. In total, 41 patients underwent nerve transfers for peroneal nerve palsy mean age of 36.1 years (range=15.0-73.0), mean time to surgery of 6.3 months (range=2.0-12.0), and a mean follow-up of 19.0 months (range=6.0-36.0). Etiology of peroneal nerve palsy was variable: common/deep peroneal nerve injury (n=25, 61%), sciatic nerve injury (n=12, 29%), and lumbar root/plexus injury (n=4, 10%). The donor nerve was either tibial nerve braches/fascicles (n=36, 88%) or the superficial peroneal nerve (n=5, 12%). The recipient nerve was either the deep peroneal nerve (n=24, 59%) or the branch to tibialis anterior (n=17, 41%). Mean postoperative ankle dorsiflexion strength was Medical Research Council (MRC) 2.1 (SD=1.8) with the following distribution: MRC 0 (n=14, 34%), MRC 1 (n=4,10%), MRC 2 (n=2, 5%), MRC 3 (n=6, 15%), MRC 4 (n=15, 37%), MRC 5 (n=0, 0%). There were no significant differences in ankle dorsiflexion strength between etiologies (p=0.491), donor (p=0.066), or recipient nerves (p=0.496). There were no significant correlations between ankle dorsiflexion strength and patient age (p=0.094) or time to surgery (p=0.493).

CONCLUSIONS: The literature exploring the outcomes of nerve transfers in patients with peroneal nerve palsy is sparse: there are no comparative studies and the retrospective series demonstrate wide variability in outcomes. Further investigations are required to better elucidate the role for nerve transfers in peroneal nerve palsy.

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