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No difference in sensory outcome between vertical and oblique incisions for hamstring graft harvest during ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy volume 27, pages 146–152 (2019)Cite this article

Abstract

Purpose

To compare the incidence, extent of sensory loss, its clinical effect and natural course caused by sensory nerve injury, during two different skin incisions used for autogenous hamstring graft harvest during ACL reconstruction.

Methods

This randomized prospective study was carried out on 84 patients, divided into two groups, all of them underwent arthroscopic ACL reconstruction using hamstring tendon graft with two incisions; a vertical incision used in 43 patients, and an oblique incision in 41 patients. The location and area of sensory loss were evaluated during follow-up as well as the degree of improvement and patient satisfaction.

Results

The average age in this study was 29.8 ± 7.2 in the vertical group and 29.9 ± 6.3 in the oblique group. Both semitendinosus and gracilles were harvested in 34 patients, semitendinosus in 49 patients and gracilles in one patient. In the vertical group, a higher incidence of sensory loss was recorded with 21 patients (51.2%), relative to the oblique group with 18 patients (41.9%). However, there was no statistically significant difference (p = n.s). Most of the sensory loss affected the distribution of the IPBSN (infrapatellar branch of saphenous nerve) in 27 patients (69.2%) in both groups, and to a lesser extent in the lower medial area [distribution of SBSN (sartorial branch of saphenous nerve)] in 12 patients (30.8%).

Conclusion

This study clearly revealed the high incidence of nerve injury particularly the IPBSN during hamstring graft harvest, but did not prove a difference between oblique and vertical incisions, with regard to postoperative sensory loss. It was clear that harvesting the semitendinosus alone is not a factor that can diminish nerve injury.

Level of evidence

II.

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Affiliations

  1. Mansoura University Hospital, Mansoura, Egypt

    Mohamed M. F. Sharaby

  2. Khoula Hospital, Mina alfahl, Muscat, Oman

    Mohamed M. F. Sharaby, Arafat Alfikey, Ismail S. Alhabsi & Suwailim Al-Ghannami

Authors
  1. Mohamed M. F. Sharaby
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  2. Arafat Alfikey
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  3. Ismail S. Alhabsi
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  4. Suwailim Al-Ghannami
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Corresponding author

Correspondence to Mohamed M. F. Sharaby.

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No external funding was used.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in this study (on human participants) were in accordance with the ethical standards of the institutional and/or the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants in this study.

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Sharaby, M.M.F., Alfikey, A., Alhabsi, I.S. et al. No difference in sensory outcome between vertical and oblique incisions for hamstring graft harvest during ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 146–152 (2019). https://doi.org/10.1007/s00167-018-5057-5

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  • DOI: https://doi.org/10.1007/s00167-018-5057-5

Keywords

  • Saphenous nerve injury
  • Hamstring graft
  • ACL reconstruction
  • Vertical incision
  • Oblique incision