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.
Similar content being viewed by others
References
Bertram C, Porsch M, Hackenbroch MH, Terhaag D (2000) Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft. Arthroscopy 16:763–766
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
Dunaway DJ, Steensen RN, Wiand W, Dopirak RM (2005) The sartorial branch of the saphenous nerve: its anatomy at the joint line of the knee. Arthroscopy 21:547–551
Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C (2008) Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 15:360–363
Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28:328–335
Kelly M, Macnicol MF (2003) Identification of the saphenous nerve at arthroscopy. Arthroscopy 19:E46
Larson RV (2001) Complications and pitfalls in anterior cruciate ligament reconstruction with hamstring tendons. In: Malek MM, Fanelli G, Johnson D et al (eds) Knee surgery. Complications, pitfalls, and salvage. Springer, New York, pp 77–88
Luo H, Yu J, Ao Y, Yu C, Peng L-B, Lin C, Zhang J, 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
Mochida H, Kikuchi S (1995) Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 320:88–94
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. Surg Radiol Anat 25:192–199
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
Pádua VBC, Maldonado H, Vilela JCR, Provenza AR, Monteiro C, Oliveira Neto HC (2012) Saphenous nerve injury during harvesting of one or two hamstring tendons for anterior cruciate ligament reconstruction. Rev Bras Ortop 47(1):50–56
Pagnani MJ, Warner JJ, O’Brien SJ, Warren RF (1993) Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med 21:565–571
Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2006) 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
Pękala PA, Tomaszewski KA, Henry BM, Ramakrishnan PK, Roy J, Mizia E, Walocha JA (2017) Risk of iatrogenic injury to the infrapatellar branch of the saphenous nerve during hamstring tendon harvesting: a meta-analysis. Muscle Nerve 56(5):930–937
Portland GH, Martin D, Keene G, Menz T (2005) Injury to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction: comparison of horizontal versus vertical harvest site incisions. Arthroscopy 21(3):281–285
Ruffilli A, De Fine M, Traina F, Pilla F, Fenga D, Faldini C (2017) Saphenous nerve injury during hamstring tendon harvest: does the incision matter? A systemic review. Knee Surg Sports Traumatol Arthrosc 25(10):3140–3145
Sabat D, Kumar V (2013) Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions. Knee Surg Sports Traumatol Arthrosc 21:2089–2095
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
Sipahioglu S, Zehir S, Sarikaya B, Levent A (2017) Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest. J Orthop Surg (Hong Kong) 25(1):1–7
Solman CG Jr, Pagnani MJ (2003) Hamstring tendon harvesting. Reviewing anatomic relationships and avoiding pitfalls. Orthop Clin N Am 34:1–8
Spicer DD, 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
Walshaw T, Karuppiah SV, Stewart I (2015) The course and distribution of the infra patellar nerve in relation to ACL reconstruction. Knee 22:384–388
Wijdicks CA, Westerhaus BD, Brand EJ, Johansen S, Engebretsen L, LaPrade RF (2010) Sartorial branch of the saphenous nerve in relation to a medial knee ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1105–1109
Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
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.
Informed consent
Informed consent was obtained from all participants in this study.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-018-5057-5