{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:41:20Z","timestamp":1787240480845,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Foot drop from peroneal nerve palsy causes steppage gait and functional disability. Tendon transfer is reliable but sacrifices native biomechanics. Distal nerve transfer (DNT) reinnervates dorsiflexors, potentially restoring more physiologic function. This study aimed to systematically review and meta\u2010analyze the clinical outcomes of DNT for foot drop and to identify key prognostic and technical factors that inform contemporary reconstructive decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following PRISMA, we searched MEDLINE, EMBASE, and Cochrane (through September 2025) for clinical studies of DNT to the deep peroneal nerve (DPN) or its branches. Primary outcome was the proportion achieving Medical Research Council (MRC) grade \u2265\u20093 dorsiflexion; secondary outcome was MRC \u2265\u20094. Pooled proportions were estimated with random\u2010effects meta\u2010analyses using binomial generalized linear mixed models, reporting 95% confidence intervals, heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      ), and 95% prediction intervals; sensitivity and small\u2010study analyses are detailed in the Supplement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten studies (nine clinical, one cadaveric;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009120) met inclusion. Across\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20097 clinical series (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009101) with extractable data, pooled MRC \u2265\u20093 was 0.57 (95% CI 0.41\u20130.72,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200959.6%,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.032, 95% PI 0.29\u20130.83). Excluding the iatrogenic series yielded 0.50 (95% CI 0.35\u20130.66;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200942.1%). For MRC \u2265\u20094 across\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20095 series (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200942), the pooled estimate was 0.33 (95% CI 0.12\u20130.58;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200967.9%,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.041, 95% PI 0.08\u20130.73). AFO independence paralleled strength recovery. Donor morbidity was low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DNT restores antigravity dorsiflexion in approximately half of appropriately selected patients, with one\u2010third reaching near\u2010normal strength. Early surgery (\u2264\u200912\u2009months) and viable anterior compartments optimize outcomes. Tendon transfer remains a reliable fallback and can be combined with DNT in complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70187","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T07:39:12Z","timestamp":1769499552000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal Nerve Transfers for Foot Drop: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3321-9255","authenticated-orcid":false,"given":"J. Terrence Jose","family":"Jerome","sequence":"first","affiliation":[{"name":"Department of Orthopedics Dhanalakshmi Srinivasan Medical College and Hospital  Perambalur Tamil Nadu India"},{"name":"Olympia Hospital &amp; Research Centre  Trichy Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Surendran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Trichy SRM Medical College  Trichy Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3323-0521","authenticated-orcid":false,"given":"Thirumagal","family":"Kuppusamy","sequence":"additional","affiliation":[{"name":"Olympia Hospital &amp; Research Centre  Trichy Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.745746"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-018-03797-x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100721997798"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.04.086"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30174"},{"issue":"6","key":"e_1_2_10_7_1","first-page":"218","article-title":"Proximal Motor Branches From the Tibial Nerve as Direct Donors to Restore Function of the Deep Fibular Nerve for Treatment of High Sciatic Nerve Injuries: A Cadaveric Feasibility Study","volume":"65","author":"Flores L. P.","year":"2009","journal-title":"Neurosurgery"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000062"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010011\u20101924\u20109"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31824c94e5"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200203000-00030"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.55275\/JPOSNA-2023-605"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1667047"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.25259\/JMSR_264_2024"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000897"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000006781"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1082894"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.25259\/SNI_146_2022"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(94)90052-3"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1104548"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.3171\/CASE24888"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fastrc.2025.100503"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70187","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70187","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:34:21Z","timestamp":1786988061000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/micr.70187"],"URL":"https:\/\/doi.org\/10.1002\/micr.70187","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70187"}}