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Excursion and Strain of the Superficial Peroneal Nerve During Inversion Ankle Sprain

O'Neill, Patrick J. MD; Parks, Brent G. MSc; Walsh, Russell BSc; Simmons, Lucia M. BSc; Miller, Stuart D. MD

Journal of Bone & Joint Surgery - American Volume: May 2007 - Volume 89 - Issue 5 - p 979–986
doi: 10.2106/JBJS.F.00440
Scientific Articles

Background: Traction is presumed to be the mechanism of injury to the superficial peroneal nerve in an inversion ankle sprain, but it is not known whether the amount of strain caused by nerve traction is sufficient to cause nerve injury. We hypothesized that the superficial peroneal nerve would experience significant excursion and strain during a simulated inversion sprain, that sectioning of the anterior talofibular ligament would increase excursion and strain, and that an impact force would produce strain in a range that can structurally alter the nerve.

Methods: Differential reluctance transducers were placed in the superficial peroneal nerve in sixteen lower-extremity cadaver specimens to measure excursion and strain in situ. Static weight was applied to the foot in increments starting at 0.454 kg and ending at 4.54 kg. The anterior talofibular ligament was sectioned, and the measurements were repeated. A final impact force of 4.54 kg was applied to each specimen. Two-way repeated-measures analysis of variance was used to evaluate differences in excursion and strain.

Results: The mean excursion and strain of the superficial peroneal nerve increased with increases in the applied weight in both the group with the intact anterior talofibular ligament and the group in which it had been sectioned. Nerve excursion was greater in the sectioned-ligament group than in the intact-ligament group with all applied weights (p < 0.05). The mean nerve strain was greater in the sectioned-ligament group (range, 5.5% to 12.9%) than in the intact-ligament group (range, 3.0% to 11.6%) with application of the 0.454, 0.908, 1.362, and 1.816-kg weights (p < 0.05). With the ligament sectioned, the 4.54-kg impact force produced significantly higher mean nerve excursion and strain than did the 4.54-kg static weight (p < 0.05).

Conclusions: The magnitude of strain with the impact force was in the lower range of values that have been shown to structurally alter peripheral nerves. The superficial peroneal nerve is at risk for traction injury during an ankle inversion sprain and is at additional risk with more severe sprains or with an insufficient anterior talofibular ligament.

Clinical Relevance: Nerve injury may contribute to the high rate of residual morbidity after inversion ankle sprains.

1 Union Memorial Orthopaedics, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218. E-mail address for S.D. Miller (c/o Lyn Camire, Editor): lyn.camire@medstar.net

Copyright 2007 by The Journal of Bone and Joint Surgery, Incorporated
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