Factors Influencing Common Fibular Nerve Course Variability before Bifurcation into the Superficial Fibular Nerve and Deep Fibular Nerve: A Cadaveric Study
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Abstract
Background and Objectives: The common fibular nerve (CFN) has anatomical variance between individuals as it transitions from the posterior thigh to the anterior leg. The nerve’s course around the fibular neck is of particular interest, where it becomes vulnerable to injury at the lateral knee. Therefore, we sought to compare factors that may predict distal CFN variability, such as height, age, sex, fibular length, and proximal sciatic variations, which individually or cumulatively play a role in predicting clinically significant locations where the CFN commonly transitions among certain populations.
Methods: In this cadaveric study, twenty anatomically-fixed specimens were analyzed, ten males and ten females. Data gathered included age, sex, height, CFN transition point measured from the proximal head of the fibular to the point 90 degrees off the midline of the fibula where the CFN courses around the fibular neck, fibular length, and proximal sciatic nerve variations characterized based on the Beaton and Anson classification system. Factors were compared and statistical values were generated.
Results: There was a statistically significant difference between CFN transition points compared to fibular lengths, heights, and between sexes. Sciatic nerve (SN) bifurcation levels and exits were bilaterally identical on all cadavers. All SN exits were Beaton and Anson type 1 (undivided nerve below and undivided piriformis), and bifurcation levels were 20% high, 25% middle, and 55% low.
Conclusions: This study highlights the importance of considering a person’s height, fibular length, and sex when addressing injuries involving the CFN at the lateral leg.
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References
I. Van den Bergh FRA, Vanhoenacker FM, De Smet E, et al. Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee. Insights into imaging. 2013; 4(3): 287-299. https://doi.org/10.1007/s13244-013-0255-7
II. Hardin JM, Devendra S. Anatomy, Bony Pelvis and Lower Limb, Calf Common Peroneal (Fibular) Nerve. StatPearls. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK532968/
III. Adibatti M, Sangeetha V. Study on variant anatomy of sciatic nerve. J Clin Diagn Res. 2014; 8(8): Ac07-09. https://doi.org/10.7860/JCDR/2014/9116.4725
IV. Beaton LE, Anson BJ. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Rec. 1937; 70: 1–5.
V. Watt T, Hariharan AR, Brzezinski DW, et al. Branching patterns and localization of the common fibular (peroneal) nerve: an anatomical basis for planning safe surgical approaches. Surg Radiol Anat. 2014; 36(8): 821-828. https://doi.org/10.1007/s00276-013-1242-x
VI. Hildebrand G, Tompkins M, Macalena J. Fibular head as a landmark for identification of the common peroneal nerve: a cadaveric study. Arthroscopy. 2015; 31(1): 99-103. https://doi.org/10.1016/j.arthro.2014.07.014
VII. Deutsch A, Wyzykowski RJ, Victoroff BN. Evaluation of the anatomy of the common peroneal nerve. Am J Sports Med. 1999; 27(1): 10-15. https://doi.org/10.1177/03635465990270010201
VIII. Poage C, Roth C, Scott B. Peroneal Nerve Palsy: Evaluation and Management. J Am Acad Orthop Surg. 2016; 24(1): 1-10. https://doi.org/10.5435/JAAOS-D-14-00420
IX. Nori SL, Stretanski MF. Foot Drop. In StatPearls. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK554393/
X. Lezak B, Summers S. Anatomy, Bony Pelvis and Lower Limb, Leg Anterior Compartment. In StatPearls. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK539725/
XI. Ryan W, Mahony N, Delaney M, et al. Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat. 2003; 16(6): 501-505. https://doi.org/10.1002/ca.10155
XII. Levy BA, Stuart MJ, Whelan DB. Posterolateral instability of the knee: evaluation, treatment, results. Sports Med Arthrosc Rev. 2010; 18(4): 254-262. https://doi.org/10.1097/JSA.0b013e3181f88527
XIII. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: A 10-year study. Knee. 2006; 13(3): 184-188. https://doi.org/10.1016/j.knee.2006.01.005
XIV. Hill OT, Bulathsinhala L, Scofield DE, et al. Risk factors for soft tissue knee injuries in active duty U.S. Army soldiers, 2000-2005. Mil Med. 2013; 178(6): 676-682. https://doi.org/10.7205/MILMED-D-13-00049
XV. LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25(4): 433-438.
https://doi.org/10.1177/036354659702500403
XVI. Rausch V, Hackl M, Oppermann J, et al. Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. Arch Orthop Trauma Surg. 2019; 139(7): 921-926. https://doi.org/10.1007/s00402-019-03141-7