{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:26:11Z","timestamp":1787009171217,"version":"build-2736575974"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Peripheral nerve blockade is commonly employed as perioperative pain management for posterolateral corner (PLC) knee reconstructions. However, common peroneal nerve (CPN) analgesia limits immediate postoperative assessment (within 0.5\u20132\u2009hours of surgery) for iatrogenic injury and may further cause a \u201csecond hit\u201d injury in cases of preoperative CPN trauma. Meanwhile, lack of lateral knee analgesia may result in intractable pain and the need for postoperative \u201crescue block.\u201d The incidence of iatrogenic peroneal nerve injury (from nerve block and\/or surgical exploration) and frequency of \u201crescue blockade\u201d remains unknown after PLC reconstruction. This study aims to identify the incidence of these events to inform the ideal perioperative anesthesia protocol. Patients who underwent PLC reconstruction at a single Level 1 academic institution were identified over a 4-year period. Medical records were queried for demographics, injury patterns, nerve blockade, surgical interventions, and perioperative nerve injury. Fifty knees were identified: 30 (60%) underwent preoperative CPN block, and 20 (40%) underwent CPN-sparing analgesia. Preoperative CPN injury was present in 20% of the cohort. Forty percent of these neurological injuries experienced improvement of symptoms shortly after neurolysis, while another 40% required further intervention. Factors determining avoidance of CPN analgesia were preoperative CPN injury (p\u2009=\u20090.030) and low-energy injury mechanism (p\u2009=\u20090.038). Of the CPN-sparing cohort, nine (45%) underwent a postoperative rescue block. Risk factors for rescue block were younger age (25.3 years vs. 39.8 years; p\u2009=\u20090.007) and lower BMI (26.5\u2009kg\/m2 vs. 33.0\u2009kg\/m2; p\u2009=\u20090.035). Incidence of iatrogenic CPN palsy following PLC reconstruction was 6%, all of which were incomplete and did not require operative intervention. Incidence of iatrogenic CPN injury was low, with only incomplete nerve palsies that did not necessitate operative intervention. Avoidance of preoperative CPN blockade allowed for immediate postoperative neurologic evaluation. However, nearly half of the CPN-sparing cohort did require a postoperative \u201crescue block.\u201d This risk was higher among younger patients with lower BMIs.<\/jats:p>","DOI":"10.1055\/a-2824-8995","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:17:17Z","timestamp":1773965837000},"page":"594-601","source":"Crossref","is-referenced-by-count":0,"title":["Common Peroneal Nerve Analgesia Considerations During Knee Posterolateral Corner Reconstruction"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0936-9966","authenticated-orcid":false,"given":"Nicholas","family":"Newcomb","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan A.","family":"Buttner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Shultz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Arndt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Painter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schenck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9935-6493","authenticated-orcid":false,"given":"Dustin","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.arthro.2007.07.024","article-title":"A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis","volume":"23","author":"R F LaPrade","year":"2007","journal-title":"Arthroscopy"},{"issue":"18","key":"ref2","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.2106\/JBJS.J.01639","article-title":"Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique","volume":"93","author":"A G Geeslin","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s00167-016-4417-2","article-title":"The incidence and clinical outcomes of peroneal nerve injuries associated with posterolateral corner injuries of the knee","volume":"26","author":"T J Ridley","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s12178-019-09581-3","article-title":"ACL and posterolateral corner injuries","volume":"13","author":"R S Dean","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"key":"ref5","first-page":"569319","article-title":"Analgesic techniques in hip and knee arthroplasty: from the daily practice to evidence-based medicine","volume":"2014","author":"D M Anastase","year":"2014","journal-title":"Anesthesiol Res Pract"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"e1409","DOI":"10.1016\/j.eats.2020.05.022","article-title":"Open anatomic reconstruction of the posterolateral corner: the arciero technique","volume":"9","author":"N L Grimm","year":"2020","journal-title":"Arthrosc Tech"},{"key":"ref7","volume-title":"Nerve Block Anesthesia","author":"B D Wiederhold","year":"2025"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.anclin.2019.01.005","article-title":"Regional anesthesia for ambulatory anesthesiologists","volume":"37","author":"A E Ardon","year":"2019","journal-title":"Anesthesiol Clin"},{"key":"ref9","volume-title":"Atlas of Human Anatomy","author":"F H Netter","year":"2019","edition":"Seventh edition"},{"issue":"14","key":"ref10","doi-asserted-by":"crossref","first-page":"3541","DOI":"10.1177\/0363546520962503","article-title":"The pathoanatomy of posterolateral corner ligamentous disruption in multiligament knee injuries is predictive of peroneal nerve injury","volume":"48","author":"J B Kahan","year":"2020","journal-title":"Am J Sports Med"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/AAP.0000000000000125","article-title":"Pathophysiology and etiology of nerve injury following peripheral nerve blockade","volume":"40","author":"R Brull","year":"2015","journal-title":"Reg Anesth Pain Med"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1136\/rapm-00115550-200809000-00003","article-title":"ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine","volume":"33","author":"J M Neal","year":"2008","journal-title":"Reg Anesth Pain Med"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1136\/rapm-00115550-200809000-00006","article-title":"Pathophysiology of peripheral nerve injury during regional anesthesia","volume":"33","author":"Q H Hogan","year":"2008","journal-title":"Reg Anesth Pain Med"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1053\/otsm.2003.35918","article-title":"Classification of knee dislocations","volume":"11","author":"R Schenck","year":"2003","journal-title":"Oper Tech Sports Med"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2106\/JBJS.20.02051","article-title":"Presentation and surgical management of multiple ligament knee injuries: a multicenter study from the surgical timing and rehabilitation (STaR) trial for MLKIs network","volume":"105","author":"K M Poploski","year":"2023","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1177\/0363546503262687","article-title":"An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique","volume":"32","author":"R F LaPrade","year":"2004","journal-title":"Am J Sports Med"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/j.arthro.2005.06.008","article-title":"Anatomic posterolateral corner knee reconstruction","volume":"21","author":"R A Arciero","year":"2005","journal-title":"Arthroscopy"},{"issue":"06","key":"ref18","first-page":"638","article-title":"Postarthroplasty \u201cpalsy\u201d and systemic neuropathy: a peripheral-nerve management algorithm","volume":"55","author":"A L Dellon","year":"2005","journal-title":"Ann Plast Surg"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1302\/0301-620X.87B9.16122","article-title":"Displacement of the common peroneal nerve in posterolateral corner injuries of the knee","volume":"87","author":"N Bottomley","year":"2005","journal-title":"J Bone Joint Surg Br"},{"issue":"12","key":"ref20","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1177\/0363546508325669","article-title":"Neurologic and vascular injuries associated with knee ligament injuries","volume":"36","author":"M E Johnson","year":"2008","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref21","first-page":"10","article-title":"Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair","volume":"27","author":"A Deutsch","year":"1999","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref22","doi-asserted-by":"publisher","first-page":"3093874","DOI":"10.1155\/2020\/3093874","article-title":"A Cadaveric Study of the Distal Biceps Femoris Muscle in relation to the Normal and Variant Course of the Common Peroneal Nerve: A Possible Cause of Common Peroneal Entrapment Neuropathy. Lazarov NE, ed","volume":"2020","author":"J H Park","year":"2020","journal-title":"BioMed Res Int."},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00402-019-03141-7","article-title":"Peroneal nerve location at the fibular head: an anatomic study using 3D imaging","volume":"139","author":"V Rausch","year":"2019","journal-title":"Arch Orthop Trauma Surg"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00402-020-03708-9","article-title":"The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions","volume":"141","author":"E Hohmann","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"ref25","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1177\/0363546520981697","article-title":"Incidence of intraoperative and postoperative complications after posterolateral corner reconstruction or repair: a systematic review of the current literature","volume":"49","author":"B Maheshwer","year":"2021","journal-title":"Am J Sports Med"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1227\/01.NEU.0000124752.40412.03","article-title":"Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center","volume":"54","author":"D H Kim","year":"2004","journal-title":"Neurosurgery"},{"issue":"08","key":"ref27","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1111\/j.1365-2044.2009.05938.x","article-title":"Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study","volume":"64","author":"M J Fredrickson","year":"2009","journal-title":"Anaesthesia"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1097\/AAP.0b013e31825cb3d6","article-title":"Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry","volume":"37","author":"B D Sites","year":"2012","journal-title":"Reg Anesth Pain Med"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/pm\/pnx045","article-title":"Comprehensive analysis of 13,897 consecutive regional anesthetics at an ambulatory surgery center","volume":"19","author":"R J Malchow","year":"2018","journal-title":"Pain Med"},{"issue":"03","key":"ref30","first-page":"263","article-title":"Nerve injection injury with local anesthetic agents: a light and electron microscopic, fluorescent microscopic, and horseradish peroxidase study","volume":"6","author":"F Gentili","year":"1980","journal-title":"Neurosurgery"},{"issue":"04","key":"ref31","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1002\/(SICI)1097-4598(199804)21:4<461::AID-MUS4>3.0.CO;2-7","article-title":"Spontaneous and evoked ectopic discharges recorded from single human axons","volume":"21","author":"V G Macefield","year":"1998","journal-title":"Muscle Nerve"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1213\/00000539-198212000-00001","article-title":"A comparative in vivo study of local neurotoxicity of lidocaine, bupivacaine, 2-chloroprocaine, and a mixture of 2-chloroprocaine and bupivacaine","volume":"61","author":"J Barsa","year":"1982","journal-title":"Anesth Analg"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1213\/ANE.0b013e3182a00767","article-title":"Peripheral nerve injury after local anesthetic injection","volume":"117","author":"S J Farber","year":"2013","journal-title":"Anesth Analg"},{"issue":"12","key":"ref34","first-page":"1222","article-title":"Case reports: type I hypersensitivity to lidocaine","volume":"6","author":"R N Haugen","year":"2007","journal-title":"J Drugs Dermatol"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/AAP.0b013e3181d2310b","article-title":"Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009","volume":"35","author":"G Di Gregorio","year":"2010","journal-title":"Reg Anesth Pain Med"},{"issue":"16","key":"ref36","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1161\/CIR.0000000000001161","article-title":"2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"148","author":"E J Lavonas","year":"2023","journal-title":"Circulation"},{"issue":"03","key":"ref37","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/AAP.0000000000000763","article-title":"Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition)","volume":"43","author":"T T Horlocker","year":"2018","journal-title":"Reg Anesth Pain Med."},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/j.1399-6576.2006.01173.x","article-title":"Inflammation and infection complications of 2285 perineural catheters: a prospective study","volume":"51","author":"M Neuburger","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"issue":"04","key":"ref39","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/AAP.0b013e31824df1ac","article-title":"Evolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management","volume":"37","author":"B J Walker","year":"2012","journal-title":"Reg Anesth Pain Med"},{"issue":"06","key":"ref40","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jopan.2015.01.017","article-title":"Peripheral nerve blocks causing increased risk for fall and difficulty in ambulation for the hip and knee joint replacement patient","volume":"31","author":"B L Crumley Aybar","year":"2016","journal-title":"J Perianesth Nurs"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2824-8995.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:47:52Z","timestamp":1787006872000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2824-8995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,8,17]]},"published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2824-8995","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]}}}