Altered sensation over the lower leg following hamstring graft anterior cruciate ligament reconstruction with transverse femoral fixation

Abstract

Reports in the literature have previously identified altered sensation following hamstring graft ACL reconstruction in the distribution of the infragenicular branch of the saphenous nerve. We propose to show that altered sensation is more extensive, and can affect function. We aimed to identify the occurrence rate, site and extent of altered sensation following hamstring graft ACL reconstruction, and the consequences on subjective functional recovery. A retrospective study was performed. One hundred and seventeen consecutive patients undergoing hamstring graft ACL reconstruction using transverse femoral fixation over a 78 month period were invited to complete a postal questionnaire. The minimum follow-up was 13 months. The response rate was 73%. Altered sensation post-operatively was described by 60%, with 37% experiencing persisting symptoms at follow-up. Symptoms were present in the distribution of the lateral sural cutaneous nerve (33%), the saphenous nerve (26%), and the infragenicular branch of the saphenous nerve (12%). Restriction of activity was described by 33% of patients, and 28% felt their rehabilitation programme was affected because of these symptoms. Our results showed that altered sensation was common and extensive in our population. We are unaware of any other published reports of altered sensation over the lateral lower leg. We conclude that occult nerve injury to the lateral sural cutaneous nerve during preparation of the transverse femoral fixation may be responsible.