Poor ankle eversion and dorsiflexion at 6 months predicts incomplete sciatic nerve recovery in closed, high sciatic nerve injuries.
Robin Babadjouni, MD1, Beina Azadgoli, MD, MS2, Julie Werner, PhD3 and Mitchel Seruya, MD4, 1Cedars Sinai Medical Center, Los angeles, CA, 2Keck School of Medicine, University of Southern California, Los Angeles, CA, 3Children's Hospital of Los Angeles, Los Angeles, CA, 4Cedars-Sinai Medical Center, Los Angeles, CA
Introduction:
Closed, high sciatic nerve injuries are a poorly understood, debilitating, and potentially permanent condition. Little is known about the natural history for functional recovery, including the pattern, degree, and timeframe for doing so. Such information could prove critical in properly setting patient expectations and in guiding treatment decisions.
Methods:
A retrospective review was conducted of all patients who presented with closed, high sciatic nerve injuries from 2014 to 2022. Data was collected on patient demographics, mechanism of injury, symptoms, and electromyography results. MRC scores were recorded on initial presentation and at subsequent follow up. For each muscle group, recovery was defined as regaining ³M3.
Results:
Eighteen patients with closed, high sciatic nerve injuries from were studied. Mechanisms of injury included positioning during non-orthopaedic (39%) versus positioning +/- traction during orthopaedic (61%) surgeries. Recovery rates for individual muscle groups were as follows: 94% knee flexion, 61% plantarflexion, 50% inversion, 22% eversion, and 17% dorsiflexion. The likelihood of complete functional recovery, defined as a MRC score of ≥ 3 in all muscle groups, decreases to 16.7% at 6 months post injury. Holding all other variables constant, the odds of reaching complete recovery of all muscle groups by 12 months after onset increased 20.9% (95% CI: [17.2, 24.6]) for each one-unit increase in ankle dorsiflexion MRC score at 6 months.
Conclusions:
In our study sample, 83% of patients remained with a foot drop. Patients with poor ankle eversion and dorsiflexion by 6 months post-injury warrant consideration for early surgical intervention and referral to a peripheral nerve specialist.
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