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The impact of sensory deficits after harvesting hamstrings autograft for ACL reconstruction

Abstract

Purpose

The aim of this study was threefold: to investigate the incidence of sensory deficits after harvesting hamstrings autografts, to localise and measure the area of altered sensibility and to investigate the impact of any sensory deficit on the patients daily life.

Methods

A consecutive series of sixty-one patients were examined for sensory deficits related to harvest of hamstrings tendons 10 years after having had an anterior cruciate ligament reconstruction. A neurological examination of the leg was performed to investigate for potential altered sensibility and to quantify the extent of the lesion. The patients answered the anterior knee symptoms (AKS) questionnaire and additional questions regarding impact on activities of daily life by any sensory deficit.

Results

Eighty-five per cent of the examined patients had sensory deficits—experienced as numbness (78 %) and paraesthesia (16 %)—distal to the site of tendon harvesting. The mean affected area was 70 (SD 62) cm2. No patients experienced sensory deficit symptoms to such a degree that it affected their activities of daily life, but the group with sensory deficit had significantly more AKS than patients without sensory deficit, as evaluated by the AKS score (P = 0.02). The most commonly reported complaints were related to strenuous activities and kneeling knee position.

Conclusions

This long-term evaluation shows that sensory deficit after hamstring tendons harvesting affects a majority of patients and is probably permanent. Most patients reported this as being only mildly bothersome, but they have significantly more AKS as assessed by the AKS questionnaire. In clinical practice, patients should be counselled prior to tendon harvesting on the incidence and characteristic of the sensory deficit along with other possible peri- and postoperative complications.

Level of evidence

Case series, Level IV.

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References

  1. Altmann DG (1991) Practical statistics for medical research. Chapmann & Hall, London

    Google Scholar 

  2. Aufwerber S, Hagströmer M, Heijne A (2012) Donor-site-related functional problems following anterior cruciate ligament reconstruction: development of a self-administered questionnaire. Knee Surg Sports Traumatol Arthrosc 20:1611–1621

    Article  PubMed  Google Scholar 

  3. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon–bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728

    CAS  PubMed  Google Scholar 

  4. Boon JM, Van Wyk MJ, Jordaan D (2004) A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction. Surg Radiol Anat 26:167–171

    Article  CAS  PubMed  Google Scholar 

  5. Drogset JO, Strand T, Uppheim G, Ødegård B, Bøe A, Grøntvedt T (2009) Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 18:1085–1093

    Article  PubMed  Google Scholar 

  6. Eriksson K, Anderberg P, Hamberg P, Olerud P, Wredmark T (2001) There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients. Scand J Med Sci Sports 11:170–177

    Article  CAS  PubMed  Google Scholar 

  7. Holm I, Øiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon–bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38:448–454

    Article  PubMed  Google Scholar 

  8. Inderhaug E, Strand T, Fischer-Bredenbeck C, Solheim E (2012) Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling. Knee Surg Sports Traumatol Arthrosc 21:2004–2010

    Article  PubMed  Google Scholar 

  9. Jameson S, Emmerson K (2007) Altered sensation over the lower leg following hamstring graft anterior cruciate ligament reconstruction with transverse femoral fixation. Knee 14:314–320

    Article  PubMed  Google Scholar 

  10. Kjærgaard J, Faunø L, Faunø P (2008) Sensibility loss after ACL reconstruction with hamstring graft. Int J Sports Med 29:507–511

    Article  PubMed  Google Scholar 

  11. Kraeutler MJ, Bravman JT, McCarty EC (2013) Bone–patellar tendon–bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med. doi:10.1177/036354651348412

    PubMed  Google Scholar 

  12. Luo H, Yu J-K, Ao Y-F, Yu C-L, Peng L-B, Lin C-Y, Zhang J-Y, Fu X (2007) Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl) 120:1127–1130

    Google Scholar 

  13. Mirzatolooei F, Pisoodeh K (2012) Impact of exploration of sensory branches of saphenous nerve in anterior cruciate ligament reconstructive surgery. Arch Iran Med 15:219–222

    PubMed  Google Scholar 

  14. Mochizuki T, Akita K, Muneta T, Sato T (2003) Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons. SRA 25:192–199

    CAS  PubMed  Google Scholar 

  15. Mochizuki T, Muneta T, Yagishita K, Shinomiya K, Sekiya I (2004) Skin sensory change after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons with a vertical incision. Knee Surg Sports Traumatol Arthrosc 12:198–202

    Article  PubMed  Google Scholar 

  16. Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2005) Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793

    Article  PubMed  Google Scholar 

  17. Prodromos CC, Han YS, Keller BL, Bolyard RJ (2005) Posterior mini-incision technique for hamstring anterior cruciate ligament reconstruction graft harvest. Arthroscopy 21:130–137

    Article  PubMed  Google Scholar 

  18. Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963

    Article  PubMed  Google Scholar 

  19. Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47

    Article  CAS  PubMed  Google Scholar 

  20. Snow BJ, Wilcox JJ, Burks RT, Greis PE (2012) Evaluation of muscle size and fatty infiltration with MRI nine to eleven years following hamstring harvest for ACL reconstruction. J Bone Joint Surg Am 18:1274–1282

    Article  Google Scholar 

  21. Spicer DDM, Blagg SE, Unwin AJ, Allum RL (2000) Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:286–289

    Article  CAS  PubMed  Google Scholar 

  22. Sujay DK, Khan WS, Rohit S (2012) Anterior cruciate ligament graft choices: a review of current concepts. Open Orthop J 6:281–286

    Article  Google Scholar 

  23. Tuncay I, Karalezli N (2008) Skin dimpling as a complication of hamstring harvesting following anterior cruciate ligament reconstruction. J Knee Surg 21:250–252

    Article  PubMed  Google Scholar 

  24. Vardi G (2004) Sciatic nerve injury following hamstring harvest. Knee 11:37–39

    Article  PubMed  Google Scholar 

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Correspondence to Eivind Inderhaug.

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Inderhaug, E., Strand, T. & Solheim, E. The impact of sensory deficits after harvesting hamstrings autograft for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 23, 1060–1064 (2015). https://doi.org/10.1007/s00167-014-2871-2

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  • DOI: https://doi.org/10.1007/s00167-014-2871-2

Keywords

  • Anterior cruciate ligament
  • Hamstrings graft
  • Sensory deficit
  • Complication