title: Peroneal Nerve Dysfunction due to Multiligament Knee Injury: Patient Characteristics and Comparative Outcomes After Posterior Tibial Tendon Transfer.
abstract: OBJECTIVE
  To objectively compare outcomes of nonoperative management and posterior tibial tendon (PTT) transfer for peroneal nerve injury due to multiligament knee injury (MLI).
  
  
  METHODS
  Retrospective cohort study with prospective follow-up.
  
  
  METHODS
  Tertiary care institution.
  
  
  METHODS
  Ten patients with peroneal nerve injury due to MLI (5 managed nonoperatively, 5 with PTT transfer) were evaluated and a control group of 4 patients without peroneal nerve injury.
  
  
  METHODS
  Clinical examination, subjective questionnaires, and 3-D motion capture gait analysis during flat-ground walking and stair descent.
  
  
  METHODS
  The primary outcome measure was the result of gait analysis. The results of subjective questionnaires were a secondary outcome measure.
  
  
  RESULTS
  Dorsiflexion was significantly reduced at initial contact and mid-late swing phase in the nonoperative cohort. The PTT transfer cohort demonstrated increased dorsiflexion at each of these time intervals compared with patients managed nonoperatively, restoring symmetry between limbs. The PTT transfer cohort demonstrated similar gait patterns to controls but tended to be more everted. Ground reaction force was increased in the uninvolved limb in the PTT transfer group during gait and step down. There were no statistically significant differences in AOFAS, FAAM, IKDC, or Lysholm results.
  
  
  CONCLUSIONS
  Posterior tibial tendon transfer is an option to restore dorsiflexion and eliminate the need for an orthosis in patients with foot drop due to MLI. Gait analysis demonstrates a significant improvement in sagittal plane ankle kinematics after PTT transfer. The trade-off is subtle instability, highlighting the dynamic stability that the PTT provides.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.forename: Grant E
authors.initials: GE
authors.lastname: Norte
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hadeed
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Park
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D007718:Knee Injuries / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve / Q000293:injuries*; D012189:Retrospective Studies; D013709:Tendon Transfer; D016896:Treatment Outcome; D055815:Young Adult