Tendoscopic Surgery for Peroneal Tendons Instability: A Literature Review

Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.

Entrapment neuropathy of common peroneal nerve by fabella:A case report

BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.

Hereditary Multiple Exostoses (HME) with Peroneal Nerve Compresion: A Case Report

Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An eleven-year-old female with complaining of left knee joint pain and progressive masses in left lower leg since 6 years ago. This complains followed by numbness and difficulty to dorso flexion motion on left ankle joint since four months ago. Physical examination showed of the bony masses was detected at the left lateral upper third lower leg with measuring about six into eight centimeters. Range of motion of left ankle joint patient had difficult to dorso flexion. X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The patient underwent left head fibula wide resection. Intraoperative findings peripheral nerve peroneal compression and was decompression. Medical rehabilitation for physiotherapy was advised. The results of the follow-up after 2 years, no pain feels and the patient was able to dorso flexion of left ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused by the mechanical or dynamic compression of a specific single segment. MRI was excellent demonstration of blood vessels compromise and represents choices with peripheral nerves structures and to measuring cartilage cap thickness for criterion of osteochondromas differentiation and exostotic grade. Complete resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that pressured by the masses and vascular problems occured. Conclusion: Hereditary multiple exostosis is an inherited disorder characterized by multiple osteochondromas. It is important to monitor all cases of HME especially if the patient complains of pain or growth of an osteochondroma. The surgical excision, with complete resection of the cartilaginous cap of the tumor, is important in preventing recurrence.

Electroacupuncture for Treatment of 12 Cases of Infantile Peroneal Nerve Injury

Infantile peroneal nerve injury,also calledperoneal paralysis,is mostly caused by intraglutealinjection.Clinically,it is characterized by foot drop,strephenopodia,digital flexion,and high leg raisingwhile walking.The authors have treated 12 cases ofperoneal nerve injury by electroacupuncture,withsatisfactory results reported as follows.

Fresh human amniotic membrane effectively promotes the repair of injured common peroneal nerve

Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with model and nerve sutured rats. These results demonstrate that fresh amniotic membrane wrapping can promote the functional recovery of sutured common peroneal nerve via regulation of expression levels of neurotrophic factors and inhibitors associated with axonal regeneration. The study was approved by the Committee on Animal Research and Ethics at the Affiliate Hospital of Zunyi Medical University, China (approval No. 112) on December 1, 2017.

Differential gene and protein expression between rat tibial nerve and common peroneal nerve during wallerian degeneration

Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.

Anatomical study of sciatic nerve and common peroneal nerve compression

BACKGROUND： Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE： To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING： Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS： Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS： A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES： （1） Anatomical characteristics of the tibial nerve and common peroneal nerve. （2） According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types-normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. （3） Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS： （1） The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. （2） A total of 76 hemispheres （73.08%） were normal, 28 were abnormal （26.92%）. The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. （3） The structures between the infrapiriform and suprapiriform foramen are where ＂the first threshold＂ sciatic nerve projects. The structures between the infrapiriform and suprapiriform gap were ＂the second threshold＂. This became the concept of ＂double threshold＂. The reduced area caused by pathological changes of ＂double threshold＂ may block and compress the sciatic nerve. Because the common peroneal nerve lies on the anterolateral side of the sciatic nerve, injury to the common peroneal nerve is more serious. CONCLUSION： Anatomical characteristics of the common peroneal nerve, as well as variation of the sciatic nerve, piriformis, and the reduced ＂double threshold＂, are the main causes of sciatic nerve injury, and are especially common in peroneal nerve injury.

Common Peroneal Nerve Palsy Secondary to a Proximal Tibiofibular Joint “Ganglion Cyst”—A Case Report and Review of Literature

Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy—a proximal tibio-fibular joint “ganglion cyst”;a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.

Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery:A case report

BACKGROUND The causes of peroneal neuropathy are various,but are rarely due to weight loss.Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery.In this report,we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery.CASE SUMMARY A 58-year-old male did not receive adequate nutritional support after biliary surgery,and showed a massive weight loss over a short period of time(body mass index;24.1 kg/m2 to 20.5 kg/m2 for 24 d).Then,foot drop occurred on both sides.Physical examination,electromyography(EMG)and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level.The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy,and received sufficient oral nutritional support.The patient gradually recovered to his original weight,and the power of the dorsiflexor of bilateral ankles improved after conservative treatment.In addition,the follow-up EMG showed signs of improvement.CONCLUSION Any abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.

Neuroelectrophysiological indexes and clinical characteristics of patients with peroneal muscular atrophy: Retrospective analysis of 24 cases

BACKGROUND: Peroneal muscular atrophy (PMA) is characterized by insidious onset, gradually progressive course of disease, very mild disability degree and easily subjecting to missed diagnosis and misdiagnosis. Nerve conductive velocity is helpful in the diagnosis of atypical cases. OBJECTIVE: To retrospectively analyze the characteristics of clinical manifestation, electromyogram (EMG), motor and sensory nerve conduction velocity of patients with PMA. DESIGN: Retrospective case analysis. SETTING: Department of Neurology, Guangzhou First People's Hospital. PARTICIPANTS: Twenty-four patients with PMA, including 16 males and 8 females, aged 5-68 years old, admitted to Guangzhou First People's Hospital between March 1996 and January 2006 were recruited. Informed consents were obtained from all the patients. METHODS: All the patients subjected to EMG and detection of nerve conduction velocity at distal end of four extremities with a Keypoint evoked potential/ EMG instrument (Denmark). Sensory and motor conduction velocity, EMG changes of upper and lower extremities were observed, and relationship of neuroelectrophysiological characteristics and clinical symptoms was analyzed. MAIN OUTCOME MEASURES: Changes in sensory and motor conduction velocity, EMG and clinical manifestations of 24 patients. RESULTS: ① All the patients suffered from insidious onset and gradually progressive course of PMA. Muscular atrophy of lower extremity was found in 14 patients, and that of upper extremity in 5 patients. ②Routine nerve conduction study showed that sensory and motor conduction velocity were stepped down, especially in 16 patients with typeⅠPMA (demyelinating pattern, nerve conduction velocity below normal level 50%). Motor nerve conduction velocity of median nerve, ulnar nerve, common peroneal nerve and tibial nerve averaged 34.8 m/s, 37.2 m/s, 16.5 m/s and 17.4 m/s, respectively; Sensory nerve conduction velocity of median nerve, ulnar nerve and sural nerve averaged 27.9%, 24.6 m/s and 3.1 m/s, respectively. Slowing conduction velocity and muscular strength involvement were disproportionate, i.e. myasthenia was relatively lessened, sensory and motor conduction velocities were greatly decreased. Nerve conduction velocity in distal end of two lower extremities was not detected in 8 patients, but who could still walk. CONCLUSION: ①PMA of patients is characterized by insidious onset and gradually progressive course of disease. Clinical symptom is the base to diagnose PMA. ②Neuroelectrophysiological study is a simple and easy-to-operate means with good reproducibility in diagnosing PMA. Patients with abnormal myasthenia in lower extremity can be detected in the early stage.

Chronic Leg Pain in Athlete Caused by Deep Peroneal Schwannoma, a Case Report

Schwannomas are benign, well-encapsulated and slow growing tumor arising from Schwann cells of the peripheral nerve sheath. They commonly saw in the head and neck, rarely from deep peroneal nerve in the lower limb. We present a case of 42-year-old active national hockey coach, who presented with mild pain and numbness over lateral aspect of left leg for 2 years. The pain was provoked by sporting activities, and was initially relieved by analgesics, until recently, hence his presentation. MRI was done and showed well-defined oval lesion within the deep intermuscular fascia between tibialis anterior and extensor halluces longus muscles. He had an open dissection, and the histology showed a diagnosis of schwannoma. Post-operative healing was uneventful, the pain and numbness improving after 12 months.

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm

Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.

RELATIONSHIP BETWEEN THE BRAIN MONO-AMINE NEUROTRANSMITTERS AND ENDOGE-NOUS OPIOID PEPTIDES DURING INHIBITION OF DEFENCE PRESSOR RESPONSE BY INPUTS OF DEEP PERONEAL NERVE IN RABBITS

It has been reported that stimulation of hypothalamic defence area (HDA) led to the increased release of central NA and other monoamine neurotransmitters,

CHANGED CONTENTS OF MONOAMINES AND THEIR METABOLITES OF CEREBROSPINAL FLUID DURING INHIBITION OF DEFENCE PRESSOR RESPONSE BY INPUTS OF DEEP PERONEAL NERVE IN RABBITS

It has been demonstrated that excitation of hypothalamic defence area (HDA) causes an increase in sympathetic activity of the cardiovascular system and changes of other functions, which may be related to the activities of central monoamines; electroacupuncture applied to "Zusanli" or deep peroneal nerve stimulation (DPNS) can inhibit HDA stimulation-induced pressor, ventricular extrasystoles and other de-

Proximal tibial and fibular physeal fracture causing popliteal artery injury and peroneal nerve injury： A case report and review of literature

Either proximal tibial or tibial physeal injuries are rare. The combination of both is even rarer, let alone causes a vascular injury. Early intervention is the key for management. We hereby present an interesting case of simultaneous proximal tibiofibular physeal injury with popliteal arterial occlusion and common peroneal nerve injury. The present case is important in two aspects： firstly it reports a very rare occurrence of simultaneous proximal tibiofibular physeal injury associated with vascular insult and common peroneal nerve injury; secondly it highlights that with timely intervention excellent results can be achieved in paediatric patients.

Acupuncture for 24 cases of peroneal nerve palsy

Objective To explore the effective therapy for peroneal nerve palsy.Methods Twenty-four cases of peroneal nerve palsy took acupuncture treatment,with acupoints of Bāfēng（八风 EX-LE 10）,Tàichōng（太冲 LR 3）,Yánglíngquán（阳陵泉 GB 34）,Xuánzhōng（悬钟 GB 39） etc.,once a day,10 times as a course.Results Twenty-four cases were all cured after 1-4 courses.Conclusion Acupuncture for peroneal nerve palsy shows a significant therapeutic effect.

Electrical Stimulation of Deep Peroneal Nerve Mimicking Acupuncture Inhibits the Pressor Response via Capsaicin-lnsensitive Afferents in Anesthetized Rats

Objective： To assess the inhibitory modulation of blood pressure by stimulation of the deep peroneal nerve （DPN） and to determine the involvement of nociceptive fibers in the modulation. Methods： All the animals were divided into six groups （A-F）. The rats in groups A and B received no pretreatment. The rats in groups C and D received subcutaneous injection of capsaicin or control vehicle, respectively, near the DPN for 2 days. Those in groups E and F had the DPN exposed to capsaicin or control vehicle, respectively, for 20 min. Subsequently, pressor responses were induced by stimulation of paraventricular nucleus （PVN） either electrically （groups A and C-F） or chemically via injection of glutamate （group B）. After two stable pressor responses （baseline）, all groups were subject to 5-min DPN stimulation followed by PVN stimulation for 10 s. Arterial blood pressure, heart rate, and electrocardiogram were recorded. The pressor response was calculated as the difference in the mean arterial pressure （MAP） before and after PVN stimulation, and changes from baseline in pressor response after DPN stimulation were compared between the groups. Results： Increases of MAP of 22.88 ＋ 2.18 mm Hg and 20.32 ＋ 5.25 mm Hg were induced by electrical （group A） or chemical （group B） stimulation of the PVN, respectively. These pressor responses were inhibited by stimulation of the DPN, and the MAP was reduced to 12.00 _＋ 2.10 mm Hg in group A （n=6, P〈0.01） and 7.00 ＋ 2.85 mm Hg in group B （n=6, P〈0.01）. Subcutaneous injection of capsaicin （125 mg/kg） near the DPN in group C （n=7） had no effect on the inhibitory effect of DPN stimulation compared with the group D （n=9）, and neither did blockade of nociceptive fibers with capsaicin in group E （n=6） compared with group F （n=8）. Conclusion： Stimulation of the DPN mimicking acupuncture has an inhibitory effect on the pressor response, and the effect is mediated by capsaicin-insensitive afferent fibers in the DPN.

Effect of exercise interventions and prophylactic devices on reducing peroneal muscle reaction time by sudden ankle perturbation:A systematic review and meta-analysis

The purpose of this study was to determine whether interventions could improve peroneal reaction time in both healthy and those with injured ankle participants based on a systematic review and meta-analysis.An electronic search of the following database was carried out:MEDLINE,ScienceDirect and SPORTDiscus(1965–2020).Studies utilising sudden ankle inversion to measure peroneal reaction times were selected.28 studies were included for the systematic review,and 18 studies for the meta-analysis.The peroneal reaction time for pre-and post-intervention were compared into two groups,Group 1 was therapeutic exercise intervention,and Group 2 was prophylactic devices.The results showed a statistically significant difference in reduced peroneal reaction time in favour of participants in the exercise group(SMD=0.74,95%CI[1.09,0.39],p<0.001,I^(2)80%),while the prophylactic devices group showed no significant difference between control and intervention group.The effect size measured was 0.81 and 0.31 in Group 1 and Group 2,respectively.Faster peroneal muscle onset reaction time post-intervention,which was found following therapeutic exercise,should be considered for rehabilitation and preventing of ankle sprain injury.

Avoiding second donor site and the second set of neck vessels in a case of absent peroneal skin perforators

This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply solely from a soleal musculocutaneous perforator originating from the posterior tibial system.In contrast,the osteo-muscular component was supplied by the peroneal vascular system.We harvested the skin paddle with its vascular supply from the posterior tibial artery separately,and the osteo-muscular fibula was harvested with its supply from peroneal vessels.In this way,we avoided violation of the second donor site for the skin paddle.In addition,we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of neck vessels for anastomosis.This technique may also be utilised in cases where the neck vessels may not be available due to previous surgeries,radiation therapy,or decision by the surgery team to not sacrifice two sets of neck vessels for anastomosis.