The patient was operated by me 18-April-2016 for damaged peroneal nerve after gross injury of the left knee. Despite the fact, that the nerve and its branches were relatively acceptable, but atrophic and they were differentially responding to high voltage motor stimulation, but in the long run no acceptable recovery of the motor fibers took place. Sensation improved to certain level.

On examination, last time 23-May-2017 the patient still having drop left foot. She underwent total knee replacement 03-December-2016. EMG was requested and performed 21-May-2017 confirming severe axonal damage of the peroneal nerve and its tributaries.

The attachment of the tibialis posterior was released from the navicular bone. The tendon of the tibialis posterior was exposed at the lower third of the foreleg and pulled up. A parallel incision lateral to the tibia below the level of the second incision was created and tunnel with widening of the interossius membrane was created posterior to the tibial bone and the tendon pushed to that area. Using fluoroscopy, the 3d cuneiform bone was identified and drilling was performed. Using Depuy Coat anchor plus 2.9 mm, the distal part of the transferred tendon was fixed to the exposed mentioned above bone and aided with further stitching to the periostium to obtain more fixation. Routine closure of the wounds. Below knee cast was applied.

Smooth postoperative recovery. She was sent to the ward.

The patient suffered left knee injury with traction injury to the peroneal nerve. Drop foot was immediately noticed after accident. Neurolysis of the common peroneal nerve and its divisions performed 16 months ago showed integrity of the neural structures, and cNAP was performed and it gave positive response, but weak. The nerves were atrophic, but the have no neuroma and mostly having fibrillary structure inside the nerves.  The patient showed improvement of the sensory pattern, such as regression of the analgesia area and disappearance of the burning sensation of the involved area. Motor activity remain the same.

It seems that neurolysis must proceed tendon transfer, to give the patient the opportunity for neural recovery.

Suppose that we cut the atrophic segments and applied neural graft. From my opinion, the postoperative results will be worse in this case.