Characteristics of Sciatic Nerve Repair With Neurolysis, End-to-end Repair, and Nerve Grafting: A Narrative Review.

Background: Sciatic nerve injury can be traumatic or iatrogenic and causes significant motor deficits. The objective was to conduct a narrative review of the effectiveness of neurolysis, end-to-end repair, and nerve grafting after isolated sciatic nerve injury. Methods: PubMed, Cochrane, MEDLINE, and Embase libraries were searched for studies evaluating functional outcomes after sciatic nerve injury following nerve grafting, neurolysis, or end-to-end repair. Results: A total of 92 patients across 11 studies treated with neurolysis (64%), nerve grafting (32%), and end-to-end repair (4%) were included. The most common mechanism of injury was iatrogenic. Patients had a mean Medical Research Council (MRC) score of 2.6 ± 1.6. The mean MRC scores for neurolysis, end-to-end repair, and nerve grafting patients were 2.9 ± 1.5, 3.3 ± 0.6, and 1.6 ± 1.6, respectively. Sixty-nine percent, 100%, and 40% of neurolysis, end-to-end repair, and nerve grafting patients, respectively, achieved good outcomes (MRC ≥ 3). Good outcomes were achieved in 72% of patients with a preoperative interval of 6 months or less, 61% with an interval of 7-12 months, and 0% with an interval greater than 12 months. Of patients with a graft length less than 12 cm, 43% achieved good outcomes, whereas 17% with lengths greater than 12 cm did. Conclusions: Patients with end-to-end repair achieved the best outcomes (MRC ≥ 3). A preoperative interval of 6 months or less and graft length less than 12 cm are more likely to be associated with better outcomes. There was no significant correlation between age, donor nerve, and mechanism of injury with final MRC scores.