{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:27:19Z","timestamp":1783124839180,"version":"3.54.6"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,9]]},"abstract":"\n OBJECT<\/jats:title>\n Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1\u20134. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.6.focus15125","type":"journal-article","created":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T03:41:33Z","timestamp":1441078893000},"page":"E8","source":"Crossref","is-referenced-by-count":18,"title":["Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation"],"prefix":"10.3171","volume":"39","author":[{"given":"Chandan G.","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"},{"name":"Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Howe","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15125","series-title":"Clin Anat","first-page":"201","article-title":"Restoration of motor function of the deep flbular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study","volume":"17","author":"Bodily","year":"2004"},{"key":"b2-focus15125","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"768","article-title":"Traumatic knee dislocation with popliteal vascular disruption: retrospective study of 14 cases","volume":"92","author":"Bonnevialle","year":"2006"},{"key":"b3-focus15125","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"508","article-title":"Dislocation and fractures around the knee with popliteal artery injury: A retrospective analysis of 54 cases","volume":"92","author":"Bonnevialle","year":"2006"},{"issue":"5","key":"b4-focus15125","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Peroneal nerve injury associated with sports-related knee injury","volume":"31","author":"Cho","year":"2011"},{"key":"b5-focus15125","series-title":"Sports Med Arthrosc Rev","first-page":"139","article-title":"Drop foot after knee dislocation: evaluation and treatment","volume":"19","author":"Cush","year":"2011"},{"key":"b6-focus15125","series-title":"Neurosurg Rev","first-page":"175","article-title":"Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer","volume":"26","author":"Ferraresi","year":"2003"},{"key":"b7-focus15125","series-title":"J Neurosurg Sci","first-page":"105","article-title":"Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases","volume":"48","author":"Garozzo","year":"2004"},{"key":"b8-focus15125","series-title":"Clin Orthop Relat Res","first-page":"779","article-title":"Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma","volume":"470","author":"Giuffre","year":"2012"},{"key":"b9-focus15125","series-title":"Knee Surg Sports Traumatol Arthrosc","first-page":"1583","article-title":"Surgical treatment of peroneal nerve palsy after knee dislocation","volume":"18","author":"Giuseffl","year":"2010"},{"key":"b10-focus15125","series-title":"Am J Sports Med","first-page":"2448","article-title":"Neurologic and vascular injuries associated with knee ligament injuries","volume":"36","author":"Johnson","year":"2008"},{"key":"b11-focus15125","series-title":"Neurosurgery","first-page":"1421","article-title":"Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center","volume":"54","author":"Kim","year":"2004"},{"key":"b12-focus15125","series-title":"Acta Orthop Scand Suppl","first-page":"80","article-title":"Knee dislocations and their management. A report of 16 cases","volume":"275","author":"Malizos","year":"1997"},{"key":"b13-focus15125","series-title":"J Pediatr Orthop","first-page":"83","article-title":"The Bridle procedure: a new treatment for equinus and equinovarus deformities in children","volume":"11","author":"McCall","year":"1991"},{"key":"b14-focus15125","series-title":"Microreconstruction of Nerve Injuries","first-page":"239","article-title":"Lower extremity nerve lesions","author":"Millessi","year":"1987"},{"key":"b15-focus15125","series-title":"J Bone Joint Surg Br","first-page":"664","article-title":"Palsy of the common peroneal nerve after traumatic dislocation of the knee","volume":"87","author":"Niall","year":"2005"},{"key":"b16-focus15125","series-title":"AJR Am J Roentgenol","first-page":"101","article-title":"Knee dislocation in overweight patients","volume":"192","author":"Peltola","year":"2009"},{"key":"b17-focus15125","series-title":"Foot Ankle","first-page":"63","article-title":"The Bridle procedure in the treatment of paralysis of the foot","volume":"13","author":"Rodriguez","year":"1992"},{"key":"b18-focus15125","series-title":"Oper Tech Sports Med","first-page":"193","article-title":"Classification of knee dislocations","volume":"11","author":"Schenck","year":"2003"},{"key":"b19-focus15125","series-title":"J Bone Joint Surg Br","first-page":"772","article-title":"Nerve grafting for traction injuries of the common peroneal nerve. 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Surgical results","author":"Wood","year":"1991"},{"key":"b1-focus15125","series-title":"Clin Anat","first-page":"201","article-title":"Restoration of motor function of the deep flbular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study","volume":"17","author":"Bodily","year":"2004"},{"key":"b2-focus15125","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"768","article-title":"Traumatic knee dislocation with popliteal vascular disruption: retrospective study of 14 cases","volume":"92","author":"Bonnevialle","year":"2006"},{"key":"b3-focus15125","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"508","article-title":"Dislocation and fractures around the knee with popliteal artery injury: A retrospective analysis of 54 cases","volume":"92","author":"Bonnevialle","year":"2006"},{"issue":"5","key":"b4-focus15125","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Peroneal nerve injury associated with sports-related knee injury","volume":"31","author":"Cho","year":"2011"},{"key":"b5-focus15125","series-title":"Sports Med Arthrosc Rev","first-page":"139","article-title":"Drop foot after knee dislocation: evaluation and treatment","volume":"19","author":"Cush","year":"2011"},{"key":"b6-focus15125","series-title":"Neurosurg Rev","first-page":"175","article-title":"Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer","volume":"26","author":"Ferraresi","year":"2003"},{"key":"b7-focus15125","series-title":"J Neurosurg Sci","first-page":"105","article-title":"Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases","volume":"48","author":"Garozzo","year":"2004"},{"key":"b8-focus15125","series-title":"Clin Orthop Relat Res","first-page":"779","article-title":"Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma","volume":"470","author":"Giuffre","year":"2012"},{"key":"b9-focus15125","series-title":"Knee Surg Sports Traumatol Arthrosc","first-page":"1583","article-title":"Surgical treatment of peroneal nerve palsy after knee dislocation","volume":"18","author":"Giuseffl","year":"2010"},{"key":"b10-focus15125","series-title":"Am J Sports Med","first-page":"2448","article-title":"Neurologic and vascular injuries associated with knee ligament injuries","volume":"36","author":"Johnson","year":"2008"},{"key":"b11-focus15125","series-title":"Neurosurgery","first-page":"1421","article-title":"Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center","volume":"54","author":"Kim","year":"2004"},{"key":"b12-focus15125","series-title":"Acta Orthop Scand Suppl","first-page":"80","article-title":"Knee dislocations and their management. A report of 16 cases","volume":"275","author":"Malizos","year":"1997"},{"key":"b13-focus15125","series-title":"J Pediatr Orthop","first-page":"83","article-title":"The Bridle procedure: a new treatment for equinus and equinovarus deformities in children","volume":"11","author":"McCall","year":"1991"},{"key":"b14-focus15125","series-title":"Microreconstruction of Nerve Injuries","first-page":"239","article-title":"Lower extremity nerve lesions","author":"Millessi","year":"1987"},{"key":"b15-focus15125","series-title":"J Bone Joint Surg Br","first-page":"664","article-title":"Palsy of the common peroneal nerve after traumatic dislocation of the knee","volume":"87","author":"Niall","year":"2005"},{"key":"b16-focus15125","series-title":"AJR Am J Roentgenol","first-page":"101","article-title":"Knee dislocation in overweight patients","volume":"192","author":"Peltola","year":"2009"},{"key":"b17-focus15125","series-title":"Foot Ankle","first-page":"63","article-title":"The Bridle procedure in the treatment of paralysis of the foot","volume":"13","author":"Rodriguez","year":"1992"},{"key":"b18-focus15125","series-title":"Oper Tech Sports Med","first-page":"193","article-title":"Classification of knee dislocations","volume":"11","author":"Schenck","year":"2003"},{"key":"b19-focus15125","series-title":"J Bone Joint Surg Br","first-page":"772","article-title":"Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases","volume":"75","author":"Sedel","year":"1993"},{"key":"b20-focus15125","series-title":"Nerve and Nerve Injuries","author":"Sunderland","year":"1972"},{"key":"b21-focus15125","series-title":"Sports Med Arthrosc Rev","first-page":"153","article-title":"Complications associated with treatment of multiple ligament injured (dislocated) knee","volume":"19","author":"Tay","year":"2011"},{"key":"b22-focus15125","series-title":"Ann Plast Surg","first-page":"169","article-title":"Vascularized nerve grafts for lower extremity nerve reconstruction","volume":"64","author":"Terzis","year":"2010"},{"key":"b23-focus15125","series-title":"Knee Surg Sports Traumatol Arthrosc","first-page":"163","article-title":"Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment","volume":"8","author":"Tomaino","year":"2000"},{"key":"b24-focus15125","series-title":"Eur Radiol","first-page":"1722","article-title":"Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens","volume":"13","author":"Trappeniers","year":"2003"},{"key":"b25-focus15125","series-title":"J Orthop Trauma","first-page":"525","article-title":"Knee dislocation: initial assessment and implications for treatment","volume":"11","author":"Wascher","year":"1997"},{"key":"b26-focus15125","series-title":"J Bone Joint Surg Br","first-page":"501","article-title":"Repair of the common peroneal nerve","volume":"77","author":"Wilkinson","year":"1995"},{"key":"b27-focus15125","series-title":"Plast Reconstr Surg","first-page":"454","article-title":"Soleal sling syndrome (proximal tibial nerve compression): results of surgical decompression","volume":"129","author":"Williams","year":"2012"},{"key":"b28-focus15125","series-title":"Microsurgery","first-page":"259","article-title":"Combined peroneal and proximal tibial nerve palsies","volume":"29","author":"Williams","year":"2009"},{"key":"b29-focus15125","series-title":"Ann Plast Surg","first-page":"322","article-title":"Anatomic site for proximal tibial nerve compression: a cadaver study","volume":"62","author":"Williams","year":"2009"},{"issue":"267","key":"b30-focus15125","series-title":"Clin Orthop Relat Res","first-page":"206","article-title":"Peroneal nerve repair. 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