Nerve Transfers for Femoral Nerve Palsy: An Updated Approach and Surgical Techniques
Blair Robert Peters, MD, Department of Surgery/Section of Plastic Surgery, Washington University School of Medicine, St Louis, MO, Austin Ha, MD, Washington University School of Medicine, St. Louis, MO and Thomas Tung, MD, Plastic Surgery, Washington University School of Medicine, Saint Louis, MO
Introduction: We previously published our techniques utilizing the anterior branch of the obturator nerve and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. This case series discusses our updated techniques, results and approach to partial and complete femoral nerve palsies using femoral nerve decompression and end-to-end (ETE) and/or supercharged end-to-side (SETS) nerve transfers.
Methods: A retrospective review of patients with femoral nerve palsies treated with our technique was conducted. Primary outcomes were active knee extension Medical Research Council (MRC) grades and Visual Analogue Scale (VAS) pain scores.
Results: Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression, as well as ETE nerve transfers to non-functional quadriceps branches and SETS nerve transfers to partially functioning quadriceps branches using the anterior branch of the obturator nerve, the sartorius nerve branches or both. The median pre-operative knee extension MRC grade was 2; the average pre-operative pain VAS score was 5.2. Post-operatively, all patients achieved MRC grade 4 or greater and subjectively noted improved strength, muscle bulk, and more natural gait. The average post-operative pain score was 2.3, a statistically significant improvement (p = 0.001).
Conclusions: Until recently few treatments were available for femoral nerve palsy. Femoral nerve decompression, as well as ETE and SETS nerve transfers from the anterior branch of the obturator nerve and sartorius nerve branches allows for meaningful functional recovery and pain relief in this patient population. An algorithm for the management of partial and complete femoral nerve palsies and detailed description of surgical techniques are presented.
Back to 2021 Abstracts