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Use of the Intrepid Dynamic Exoskeletal Orthosis in the Management of Common Peroneal Nerve Palsy after Knee Dislocation

Quacinella, Michael, DO, MPH, LT, MC, USN; Mazzone, Brittney, PT, DPT; Kuhn, Kevin, MD, CDR, MC, USN; Wyatt, Marilynn, PT, MA

JPO: Journal of Prosthetics and Orthotics: January 2019 - Volume 31 - Issue 1 - p 11–15
doi: 10.1097/JPO.0000000000000217
ORIGINAL RESEARCH ARTICLES

Introduction The intrepid dynamic exoskeletal orthosis (IDEO) is a custom high-level floor reaction ankle-foot orthosis (AFO) designed specifically for the war limb salvage military population. The use of the IDEO has not been described in the management of foot drop after common peroneal nerve (CPN) palsy after knee dislocation. We present two case reports demonstrating the efficacy the IDEO in treating active-duty service members with foot drop after CPN palsy.

Method Two active-duty male Marines sustained CPN injury and foot drop after knee dislocation as a result of noncontact sports injuries. The IDEO was selected based on both patients' functional limitations despite surgical reconstruction. Both expressed a desire to return to unrestricted active-duty military duty. The IDEO was selected for treatment based on prior successes in limb salvage patients. A three-dimensional gait analysis was performed with the patient ambulating at a self-selected speed under three conditions: 1) barefoot, 2) shod without orthosis, and 3) IDEO with shod. Variables of interest were spatiotemporal and gait kinematics, return to active-duty status, gait symmetry, and Comprehensive High-Level Activity Mobility Predictor (CHAMP) scores.

Results Sagittal plane kinematics improved while ambulating with the IDEO demonstrating improved steppage gait. Spatiotemporal variables, specifically velocity and cadence, were improved with both the AFO and the IDEO. The most symmetrical gait pattern was observed while using the IDEO. The patients demonstrated their ability to run by completing the CHAMP test with the IDEO. Both patients were cleared for active duty.

Conclusions The measured improvements in gait kinematics, spatiotemporal variables, gait symmetry, and CHAMP scores as a result of the IDEO show significant functional benefit, making it a useful adjuvant therapy in patients who are motivated to achieve the maximal functional outcome after this devastating injury.

MICHAEL QUACINELLA, DO, MPH, LT, MC, USN is affiliated with the Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California.

BRITTNEY MAZZONE, DPT, PT is affiliated with the Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, San Diego, California.

KEVIN KUHN, MD, CDR, MC, USN is affiliated with the Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California.

MARILYNN WYATT, PT, MA is Director of NMCSD Gait Lab, Naval Medical Center San Diego, San Diego, California.

Disclosure: The authors declare no conflict of interest.

Correspondence to: Michael Quacinella, DO, MPH, LT, MC, USN, Naval Medical Center San Diego, 34800 Bob Wilson, San Diego, CA 92104; email: Michael.a.quacinella.mil@mail.mil

© 2019 by the American Academy of Orthotists and Prosthetists.