Functional limb salvage requires motor and sensory reconstruction of the extremity. An avulsion of the tibial nerve in the popliteal fossa after arthroscopy is presented. Functional limb recovery necessitated intraoperative nerve mapping by awake stimulation, neurotization of the gastrocnemius muscle bellies, and interfascicular posterior tibial nerve grafting. Eighteen-month follow-up demonstrated good gastrocnemius motor function and protective sensation on the plantar surface. The patient is ambulatory without the need of an assistive device.
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