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Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

The aim of this study was to improve surgical techniques for arthroscopically-assisted anterior cruciate ligament (ACL) reconstruction with minimal sensory disturbance in the infrapatellar and anterior lower leg regions. Thirteen patients with sensory disturbance were examined neurologically, and 51 lower limbs of 26 adult cadavers were examined anatomically to investigate the nerve branches supplying the regions. The region of sensory disturbance was supplied by branches of the medial femoral cutaneous nerve and the saphenous nerve, and the nerves showed a complementary distribution area. After detailed investigation of the positional relationships between the nerve branches and the skin incisions of the operative procedure, it was found that at least one branch of both nerves ran across the longitudinal skin incision (80%) for tendon harvest in the above-mentioned reconstruction. The complicated anatomic variations of the nerve branches preclude their absolute avoidance in any surgical incision, and a completely safe zone could not be found in the present study. However, an oblique incision for the tendon harvest rather than the typical longitudinal incision should be considered to minimize the sensory disturbance.

Résumé

L'objectif de cette étude était d'améliorer les techniques chirurgicales assistées par arthroscopie pour la reconstruction du ligament croisé antérieur, en diminuant les troubles sensitifs de la région infra-patellaire ou de la jambe sous-jacente. 13 patients avec des troubles sensitifs ont fait l'objet d'un examen neurologique, et 51 membres inférieurs de 26 cadavres adultes ont été étudiés pour préciser les rameaux nerveux responsables des territoires sensitifs. Les troubles sensitifs étaient présents dans des territoires innervés par des branches du nerf cutané fémoral médial et du nerf saphène, et les nerfs montraient des aires de distribution complémentaires. Après une étude détaillée des rapports topographiques entre les rameaux nerveux et les incisions cutanées de la technique opératoire, il apparaissait qu'au moins une branche de chaque nerf traversait l'incision longitudinale (81%) pour le prélèvement des tendons. Les variations anatomiques compliquées des branches nerveuses ne permettaient pas d'éviter totalement leur lésion, quelle que soit l'incision chirurgicale, et une zone de sécurité complète n'a pas pu être mise en évidence dans cette étude. Cependant, une incision oblique pour le prélèvement tendineux plutôt que l'incision longitudinale typique semble pouvoir limiter la survenue de troubles sensitifs.

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Authors and Affiliations

  1. Section of Orthopedic Surgery, Division of Bio-Matrix, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan

    T. Mochizuki & T. Muneta

  2. Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan

    K. Akita & T. Sato

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  1. T. Mochizuki
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  2. K. Akita
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  3. T. Muneta
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Correspondence to K. Akita.

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Mochizuki, T., Akita, K., Muneta, T. et al. Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons. Surg Radiol Anat 25, 192–199 (2003). https://doi.org/10.1007/s00276-003-0130-1

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