Abstract
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.
Highlights
The infrapatellar branch of the saphenous nerve (IPBSN) is a cutaneous nerve of the lower limb which arises distal to the adductor or subsartorial canal (Fig. 1) [10]
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]
Different types of surgical incisions (Fig. 2) at the area for hamstring tendon harvesting are related to variable risk of injury to the IPBSN [28]
Summary
The infrapatellar branch of the saphenous nerve (IPBSN) is a cutaneous nerve of the lower limb which arises distal to the adductor or subsartorial canal (Fig. 1) [10]. Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures which may result in IPBSN injury. 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]. Proximity of the hamstring tendons (semitendinosus and gracilis tendons) at the pes anserinus area to the IPBSN predisposes the nerve to damage during harvesting [25]. Different types of surgical incisions (Fig. 2) at the area for hamstring tendon harvesting are related to variable risk of injury to the IPBSN [28]. Horizontal, and even oblique incision methods have been proposed to reduce the risk of nerve injury based on anatomical findings of the IPBSN distribution [16, 19, 22, 24]. No consensus has been reached regarding the optimal incision method at the pes anserinus area for hamstring
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