Comparative efficacy of surgical methods in the treatment of foot drop associated with isolated peroneal nerve neuropathy

Introduction Footdrop secondary to isolated peroneal nerve neuropathy is associated with limited mobility affecting the quality of life. Objective data on comparative efficacy of surgical techniques are needed for long-term muscle denervation with nerve interventions being ineffective.

The objective was to determine the optimal surgical strategy for restoring dorsiflexion of the foot in case of isolated injury to the peroneal nerve through comparative analysis of the results of tenodesis of the extensor digitorum longus and posterior tibial muscle trasfer.

Material and methods Outcomes of 84 patients with isolated peroneal nerve neuropathy confirmed by electroneuromyography and lasting more than 12 months were prospectively analyzed. The first group included 42 patients treated with tenodesis of the extensor digitorum longus tendon to the anterior border of the tibia using a modified Lambrinudi technique. The second group consisted of 42 patients who underwent transfer of the posterior tibial muscle through the interosseous membrane with fixation to the lateral cuneiform bone using the Bridle technique. Functional assessment was produced using the AOFAS score, measuring dorsiflexion amplitude with goniometry, ankle dorsiflexor strength with dynamometer and stabilometric analysis of gait parameters at checkpoints of three, six, 12, and 24 months after surgery. Statistical processing was performed using parametric and nonparametric criteria at a significance level of < 0.05.

Results Between-the-group comparison revealed a statistically significant advantage of the muscle transfer evaluated with AOFAS (p = 0.003) and range of motion measurements (p = 0.001). Dynamometry showed dorsiflexion strength restored to 62.4 % of the contralateral limb in the first group and to 78.9 % in the second group (p < 0.001). Stabilometric analysis recorded a reduction in the center-of-pressure total trajectory length by 34.8 % with tenodesis and by 51.6 % with muscle transposition relative to preoperative values. The complication rate was 14.3% after tenodesis and 9.5 % after transfer (p = 0.386).

Discussion The superiority of the posterior tibial transfer can be explained by active muscle traction, as opposed to passive stabilization with tenodesis, which ensures a more physiological restoration of motor function. The strength and stabilometric parameters restored correlates with international data on the high effectiveness of active muscle transpositions during long-term denervation. Comprehensive postoperative rehabilitation using modern biofeedback technologies helps optimize the functional results of both techniques.

Conclusion Tibialis posterior muscle transfer demonstrated a statistically and clinically significant advantage over tenodesis of the extensor digitorum longus in restoration of the dorsiflexion function in patients with isolated peroneal nerve neuropathy lasting more than 12 months. The need to integrate personalized rehabilitation programs into the surgical treatment was supported by differences in the recovered ankle function and biomechanical gait parameters.

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