Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Abstract

Purpose: To study the short-term outcomes of anterior cruciate ligament reconstruction (ACLR) with hamstring grafts by comparing the risk of injury to the infrapatellar branch of the saphenous nerve (IPBSN) in terms of the incidence of knee hypoesthesia using 30°, 45°, and 60° oblique incisions. Methods: We conducted a randomized controlled trial among patients who underwent ACLR with hamstring grafts in Buriram Hospital between December 1, 2020 and December 31, 2021. We randomly allocated 111 patients to three groups of 37 patients each, and each group underwent either a 30°, 45°, or 60° oblique incision for hamstring graft harvesting. When incisions were being performed, the age, sex, body mass index, diagnosis, incision length, and operating time were recorded. The incidence and area of knee hypoesthesia were evaluated at 1-, 3-, and 6- month follow-ups. Results: Demographic and surgical data were similar in all three groups. The incidence of knee hypoesthesia was significantly lower in the 45°-incision group than that in other groups at 1-, 3-, and 6-month follow-ups. At the 6-month follow-up, the incidence was 8.1% in the 45° group, 45.9% in the 30° group, and 35.1% in the 60° group. The area of sensory loss in the 45° group was significantly smaller than that in the other two groups at 3- and 6-month follow-ups. Conclusions: Performing a 45° oblique incision reduced the risk of the IPBSN injury after ACLR with a hamstring graft more significantly than a 30° or 60° incision. This technique is safe, uncomplicated, and efficacious.