Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest

Abstract

The goal of this study is to evaluate the incidence rate of iatrogenic injuries to the infrapatellar branch(es) of saphenous nerve during ACL reconstruction with four-strand hamstring tendon autograft. Retrospective review of 226 patients that underwent 230 arthroscopically assisted primary ACL reconstructions with four-strand hamstring tendon autograft, between March 2002 and December 2004. The patients were separated into two groups. In group 1 (116 knees) the tendon was harvested and tibia prepared through a 3-cm vertical surgical incision (between March 2002 and September 2003) and in group 2 (114 knees) through a 3-cm horizontal surgical incision (between October 2003 and December 2004). In group 1, we found 39.7% of the patients with disturbed sensitivity in the area of the infrapatellar branch(es) of the saphenous nerve distribution. In patients of group 2 the incidence of nerve injury was 14.9% (P<0.001). The horizontal surgical incision in harvesting hamstrings tendon autograft for ACL reconstruction was found to have less associated chance of iatrogenic injury to the infrapatellar branch(es) of the saphenous nerve. No technical ties were found in both incisions for graft harvest.

Saphenous nerve injury during hamstring tendons harvest: Does the incision matter? A systematic review

“…In our opinion, routinely surgical nerve exploration seems to be excessive, principally considering the recorded higher rate of ineffectiveness of this approach. The most effective method aimed to reduce infrapatellar branch damaging according to several authors is represented by the adoption of an oblique or horizontal orientation of the incision for pes anserinus tendon harvest [12,13,16].…”

“…For this reason, many authors postulated that an horizontal or oblique incision should permit to spare the infrapatellar branch being parallel to the nerve branches course [12,13,16].…”

Proximal Saphenous Nerve Entrapment: Thigh and Knee

“…58.6 ) and then descends through the anteromedial thigh with the femoral artery and vein to the adductor (Hunter's) canal . The femoral vessels travel posteriorly toward the popliteal fossa , while the SN and descending genicular branch of the femoral artery penetrate the vastoadductor membrane , the dense connective tissue between the adductor magnus and the vastus medialis muscles, about 10 cm above the medial [ 8 , 9 ] Patellar tendon harvest [ 10 ] Hamstring tendon harvest [ 11 ] Arthroscopy [ 12 , 13 ] Trauma Medial knee trauma [ 14 , 15 ] Knee joint injection [ 16 ] Idiopathic [ 17 ] femoral epicondyle ( Fig. 58.7 ).…”

Transtendinous course of the infrapatellar branch of saphenous nerve. A contribution to the aetiology of entrapment neuropathy and modification of the existing classification

“…In 75% of the population the IPBSN consists of more than one branch and contributes to the formation of the peripatellar nerve plexus along with the anterior and lateral femoral cutaneous nerves. Following the formation of the IPBSN, the saphenous nerve descends to the medial side of the knee giving off cutaneous branches which supply the medial border of the tibia down to the medial side of the foot [14]. The IPBSN may consist of one to three branches [4].…”