Tibial and Common Peroneal Nerve Compression in The Popliteal Fossa: A Case Report and Literature Review

Abstract

This case report describes an uncommon compressive neuropathy involving both the common peroneal and tibial nerves as they pass through the popliteal fossa. The patient is a 16-year-old male who sustained a right knee fracture-dislocation. There was disruption of the popliteal artery, which was repaired with a reversed saphenous vein graft. This surgery was complicated by a postoperative hematoma. After drainage of the hematoma, the patient developed a progression neuropathy over the next 6 months that involved the common peroneal nerve and to a lesser extent the tibial nerve. Foot drop, muscle wasting of posterior and anteriolateral compartment and sensory loss over the dorsal foot and lateral leg were also documented. Based on the history, clinical finding and electrodiagnostic studies, the patient had both a tibial and common peroneal neuropathy. The neuropathy was related to the accident, but the exact etiology was unknown prior to surgical exploration. Surgical exploration was performed 15 months following the injury after referral to our institution and thick fibrous scar tissue was found compressing both tibial and common peroneal nerves. These bands were released and complete internal neurolysis was performed on both nerves. Although uncommon, surgical nerve compression can occur following extensive scarring secondary to trauma or surgical procedures. This discussion will describe the history of compressive neuropathies in the popliteal fossa. We will review the relevant literature and anatomy of this disease and describe disease progression and treatment options.