Transection of the Common Peroneal Nerve During Harvesting of Tendons for Anterior Cruciate Ligament Reconstruction

Abstract

Reconstruction of the anterior cruciate ligament with use of harvested hamstring tendon is a common surgical technique. We present a case of complete transection of the common peroneal nerve as a complication of this procedure. The case highlights the importance of careful operative technique as well as timely exploration of a nerve that ceases to function following a surgical procedure over the course of that nerve. The patient was informed that data concerning the case would be submitted for publication. A twenty-eight-year-old woman with anterior cruciate ligament deficiency and an unstable knee underwent an arthroscopically assisted right anterior cruciate ligament reconstruction with use of autologous hamstring tendon. She was previously fit and active and working as a livery manager until she sustained an injury to her knee during a skiing accident. The procedure was described by the experienced operating surgeon as entirely routine. Both the semitendinosus and gracilis tendons were harvested. A Linvatec (ConMed Linvatec, Swindon, United Kingdom) blunt-ended tendon stripper was used to harvest the tendon grafts. A tourniquet inflated to 350 mm Hg of pressure was applied to the thigh for eighty minutes. Immediately postoperatively, the patient was noted to have a painless common peroneal nerve palsy. The patient had a history of sciatica, so initial investigation included magnetic resonance imaging of the lumbar spine, the results of which were normal. Neurophysiological studies two months postoperatively, however, confirmed a complete lesion of the common peroneal nerve, with loss of conduction and fibrillation potentials in sampled muscles. The patient was referred to our care three months after the anterior cruciate ligament reconstruction. The common peroneal nerve palsy was deep and complete. A strongly positive Tinel sign was elicited in the midportion of the thigh, and there was weakness of the lateral hamstrings in the affected limb. A pressure sore …