Anatomical Landmarks for Decompression of Common Peroneal Nerve: A Cadaveric study

Background: Common peroneal nerve (CPN) neuropathy may result from trauma or iatrogenic injury. Complete decompression requires precise incision placement. This study aimed to define surface landmarks and incisional guidelines for optimal CPN decompression. Methods: Thirty lower limbs from 15 cadavers were studied with knees flexed at 90 degrees. Dissection exposed the CPN, allowing measurement of compression sites between the intermuscular septa and distances from key anatomical landmarks. The CPN angle to the fibular axis and distances from the tibial tubercle and crest were measured by 2 orthopedic surgeons. Results: The mean compression length between the anterior crural intermuscular septum and posterior crural intermuscular septum (PCIMS) was 25.2 ± 5.1 mm, and between the PCIMS and innominate intermuscular septum was 35.6 ± 6.4 mm. Mean distances from bony landmarks to the CPN were 19.0 ± 4.4 mm from the fibular head, 29.4 ± 4.5 mm from the fibular tip, and 54.7 ± 5.6 mm from the Gerdy tubercle. The anterior crural intermuscular septum was located 35.2 ± 12.1 mm distal to the tibial tubercle and 43.2 ± 8.6 mm posterior to the tibial crest, whereas the PCIMS was 22.1 ± 9.1 mm distal and 65.6 ± 8.3 mm posterior. The CPN lay 37.4 ± 6.6 degrees from the fibular axis at the fibular neck. Conclusions: A 37-degree orientation from the fibular neck provides a simple, reproducible guideline for incision planning in CPN decompression. The tibial tubercle and tibial crest serve as confirmatory landmarks to ensure complete release of the intermuscular septa.