“…The IPBSN usually innervates the skin on the anteromedial aspect of the knee between the patellar apex and tibial tuberosity [ 28 ]. Damage to the IPBSN has been reported after ACL reconstruction using hamstring tendon autografts [ 8 , 19 , 30 ]. Several authors have suggested that iatrogenic injury to the nerve may occur during skin incision, subcutaneous dissection, portal placement, tendon harvesting, or tibial tunnel drilling [ 6 , 19 , 20 , 26 ].…”
Section: Discussionmentioning
confidence: 99%
“…The anatomy of the IPBSN varies among individuals and can even vary in both limbs of the same individual [ 12 ]. Iatrogenic injury of the IPBSN is associated with many surgical interventions involving the medial aspect of the knee resulting in sensory symptoms, neuropathic pain, and painful neuroma [ 1 , 2 , 5 , 6 , 8 , 12 , 14 , 18 , 19 , 27 , 30 ]. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures which may result in IPBSN injury. The procedure is often performed using either a hamstring tendon or a patellar tendon autograft [ 30 ]. Although hamstring tendon harvesting carries less risk of injury to the IPBSN between the two approaches, postoperative complications are not uncommon and vary between 12 and 88% [ 28 ].…”
PurposeIatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus.MethodsThis study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury.ResultsThe vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5–3.6) and 1.8 (95% 1.2–2.8), respectively.ConclusionsThe vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.
“…The IPBSN usually innervates the skin on the anteromedial aspect of the knee between the patellar apex and tibial tuberosity [ 28 ]. Damage to the IPBSN has been reported after ACL reconstruction using hamstring tendon autografts [ 8 , 19 , 30 ]. Several authors have suggested that iatrogenic injury to the nerve may occur during skin incision, subcutaneous dissection, portal placement, tendon harvesting, or tibial tunnel drilling [ 6 , 19 , 20 , 26 ].…”
Section: Discussionmentioning
confidence: 99%
“…The anatomy of the IPBSN varies among individuals and can even vary in both limbs of the same individual [ 12 ]. Iatrogenic injury of the IPBSN is associated with many surgical interventions involving the medial aspect of the knee resulting in sensory symptoms, neuropathic pain, and painful neuroma [ 1 , 2 , 5 , 6 , 8 , 12 , 14 , 18 , 19 , 27 , 30 ]. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures which may result in IPBSN injury. The procedure is often performed using either a hamstring tendon or a patellar tendon autograft [ 30 ]. Although hamstring tendon harvesting carries less risk of injury to the IPBSN between the two approaches, postoperative complications are not uncommon and vary between 12 and 88% [ 28 ].…”
PurposeIatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus.MethodsThis study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury.ResultsThe vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5–3.6) and 1.8 (95% 1.2–2.8), respectively.ConclusionsThe vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.
“…3 The nerve most commonly transverses the patellar tendon, in between the patellar apex (PA) and the tibial tuberosity, with one to three medial side branches and three to six midline branches. 4 Branches of the IPBSN usually terminate between the patella and the tibial tuberosity by communicating with branches of the medial femoral cutaneous nerve originating from the femoral nerve, thus forming the infrapatellar subsartorial plexus. 1,5 High variability of the emergence, course, branching, termination, and morphometrics of IPBSN creates a substantial risk of injury during traumatic events, such as motor vehicle accidents or during surgical interventions on the anteromedial aspect of the knee.…”
The infrapatellar branch of the saphenous nerve (IPBSN) is a cutaneous nerve of the lower limb, which arises distal to the adductor canal. High variability in the emergence, course, branching, termination, and morphometrics of the IPBSN poses an increased risk of injury to the nerve during surgical interventions on the anteromedial aspect of the knee. The aim of this study was to describe the anatomical characteristics of the IPBSN. This study utilized cadaveric ( = 100) and ultrasonography ( = 30) assessments, and meta-analysis. In the cadaveric study, the presence of IPBSN and its emergence mode in relation to the sartorius muscle (SaM) was determined (type A-anterior; type B-posterior; type C-penetrating the SaM). Ultrasonography examinations were conducted on healthy volunteers to determine the presence and mode of the emergence of the nerve. Finally, from electronic databases searching, all studies reporting the IPBSN emergence data were pooled into a meta-analysis. The mean distance between the medial border of the patellar ligament (MBPL) and the IPBSN at the level of the patellar apex (PA) was also analyzed in the cadaveric, ultrasonography, and meta-analysis portions of the study. Six studies ( = 336 limbs), including the present cadaveric study, were pooled into the meta-analysis of emergence. The most prevalent IPBSN emergence mode was type C (42.9%) followed by type B (41.9%) and type A (15.4%). In the ultrasonography assessment, type A was found to be the most common (82.8%). The mean distance between the MBPL and the IPBSN at the level of the PA was 4.89 ± 0.22 cm, and 5.57 ± 0.91 cm, for the cadaveric and meta-analysis studies combined, and the ultrasonography assessment, respectively. This multimodality study shows that the most common type of IPBSN emergence is type C. The horizontal distance between the MBPL and the IPBSN at the level of the PA is usually between 4.5 and 5.6 cm. Understanding the anatomy of IPBSN emergence is crucial for orthopedic surgeons to minimize the risks of iatrogenic nerve injury during surgical procedures in the region.
“…From cadaveric dissections, 23,24 it is clear that the damage to the infrapatellar nerve branches is unavoidable when a midline approach is used to harvest a patellar tendon graft. The location of these branches is highly variable; however, they consistently terminate over the patellar tendon ( Figure 2).…”
Purpose: Tendon harvesting for anterior cruciate ligament (ACL) reconstruction often injure sensory branches of the saphenous nerve (SN). Our purpose was to estimate the prevalence and postoperative course of sensory nerve injuries in bone patellar tendon bone (BPTB) autograft harvesting for ACL reconstruction. Methods: Between 2012 and 2014, patients who had primary ACL with BPTB autograft were included (n ¼ 60) and interviewed specifically for sensory loss and its recovery. The surface area of sensory loss was documented. Evaluation also included demographic details, level of activity, and description of postoperative sensation disturbances. Results: The mean postoperative follow-up time was 24 + 14 months. At the last follow-up, 46 (77%) patients reported on postoperative reduced sensation; however, only 35 (58%) remained with sensation loss. The most involved region of reduced sensation was of the infrapatellar branch of the SN. Three patients claimed they regret to have had the surgery specifically because of sensation loss and kneeling difficulties, while all others did not. Conclusion: Primary ACL reconstruction using the midline incision for harvesting the middle third of the patellar tendon autograft has a high prevalence of sensory nerve injury with a minor possibility for complete recovery within the first year. However, sensory loss secondary to this injury does not impair normal daily activities in these patients.
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