Treatment approach to isolated common peroneal nerve palsy by mechanism of injury: Systematic review and meta-analysis of individual participants’ data

Abstract Background Individual participant data was reviewed of patients who sustained isolated common peroneal nerve (CPN) injuries resulting in foot drop. Functional results were compared between eight interventions for CPN palsies to determine step-wise treatment approaches for mechanisms of nerve injury. Methods PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL databases were searched. PRISMA-IPD and Cochrane guidelines were followed. Eligible patients sustained isolated CPN injuries resulting in foot drop. Patients were stratified by mechanisms of nerve injury, ages, durations of motor symptoms, and nerve defect/zone of injury sizes and compared by functional results (poor=0, fair=1, good=2, excellent=3), using meta-regressions between interventions. Interventions evaluated were primary neurorrhaphy, neurolysis, nerve grafts, partial nerve transfer, neuromusculotendinous transfer, tendon transfer, ankle-foot orthosis (AFO), and arthrodesis. Results One hundred and forty-four studies included 1284 patients published from 1985 through 2020. Transection/Cut: Excellent functional results following tendon transfer (OR:126, 95%CI:6.9, 2279.7, p=0.001), compared to AFO. Rupture/Avulsion: Excellent functional results following tendon transfer (OR:73985359, 95%CI:73985359, 73985359, p Conclusions Functional results may be optimized for treatments by mechanism of nerve injury. Transection/Cut and Traction/Stretch had best functional results following tendon transfer. Rupture/Avulsion had best functional results following tendon transfer, nerve graft, or neuromusculotendinous transfer. Entrapment had best functional results following neurolysis.