A modified oblique incision in hamstring tendon graft harvesting during ACL reconstruction

Zhu, Biao; Li, Xuelei; Lou, Tengteng

doi:10.1186/s13018-021-02341-5

Cited by 7 publications

(7 citation statements)

References 30 publications

(12 reference statements)

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“…There were no significant differences between the groups. The average length of incision in this study was similar to that of the other study (2.3-3.9 cm) (20) . This study had some limitations.…”

Section: Discussionsupporting

confidence: 89%

“…Therefore, safe zones must be used with caution in clinical practice. Zhu et al (20) designed a modified oblique incision (MOI) within the safe area proposed by Kerver et al and reported that the incidence of knee hypoesthesia at 1 year with the MOI was lower than that with a standard oblique incision (9.4% vs. 33.3%). Differences were considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

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Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Sooksanit

2023

JseaOrtho

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Purpose: To study the short-term outcomes of anterior cruciate ligament reconstruction (ACLR) with hamstring grafts by comparing the risk of injury to the infrapatellar branch of the saphenous nerve (IPBSN) in terms of the incidence of knee hypoesthesia using 30°, 45°, and 60° oblique incisions. Methods: We conducted a randomized controlled trial among patients who underwent ACLR with hamstring grafts in Buriram Hospital between December 1, 2020 and December 31, 2021. We randomly allocated 111 patients to three groups of 37 patients each, and each group underwent either a 30°, 45°, or 60° oblique incision for hamstring graft harvesting. When incisions were being performed, the age, sex, body mass index, diagnosis, incision length, and operating time were recorded. The incidence and area of knee hypoesthesia were evaluated at 1-, 3-, and 6- month follow-ups. Results: Demographic and surgical data were similar in all three groups. The incidence of knee hypoesthesia was significantly lower in the 45°-incision group than that in other groups at 1-, 3-, and 6-month follow-ups. At the 6-month follow-up, the incidence was 8.1% in the 45° group, 45.9% in the 30° group, and 35.1% in the 60° group. The area of sensory loss in the 45° group was significantly smaller than that in the other two groups at 3- and 6-month follow-ups. Conclusions: Performing a 45° oblique incision reduced the risk of the IPBSN injury after ACLR with a hamstring graft more significantly than a 30° or 60° incision. This technique is safe, uncomplicated, and efficacious.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Sooksanit

2023

JseaOrtho

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“…This is supported by Zhu et al. [ 26 ], who reported that the area of hypoaesthesia gradually decreases with time and even recovers completely. Various studies [ 18 , 26 – 28 ] have reported the area of sensory loss for different methods of skin incision, but this is the only study to have assessed sensory changes by two different techniques of graft harvest [by detaching sartorial fascia (IO group)/without detachment (OI group)].…”

Section: Discussionsupporting

confidence: 67%

“…[ 26 ], who reported that the area of hypoaesthesia gradually decreases with time and even recovers completely. Various studies [ 18 , 26 – 28 ] have reported the area of sensory loss for different methods of skin incision, but this is the only study to have assessed sensory changes by two different techniques of graft harvest [by detaching sartorial fascia (IO group)/without detachment (OI group)]. In this study, an oblique skin incision was used in both groups since this incision is associated with less iatrogenic nerve injury/fewer complications, as reported in anatomical studies [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Outside-in technique versus inside-out semitendinosus graft harvest technique in ACLR: a randomised control trial

Sundararajan

Ramakanth

Jha

et al. 2022

Knee Surg & Relat Res

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Background Paraesthesia after hamstring graft harvest is a ubiquitous complication in the early post-operative period, and its correlation with vertical versus horizontal skin incision are well documented. The purpose of the study is to evaluate the incidence and extent/area of sensory loss of saphenous nerve branches occurring with the outside-in (OI) versus inside-out technique (IO) of semitendinosus graft harvest from the sartorius fascia and to determine a better method of graft harvest. Methods Sixty patients who underwent isolated semitendinosus graft harvest during anterior cruciate ligament reconstruction (ACLR) between 2016 and 2017. Patients were randomised into two groups depending on the graft harvest technique: 30 in the OI group and 30 in the IO group. The area of sensory loss was mapped on the patients’ skin using tactile feedback from the patients at each follow-up (10 days, 1 month, 3 months, 6 months and 1 year). Then, the area of sensory changes for the infrapatellar branch (IPBSN) and sartorial branch (SBSN) of the saphenous nerve, incision length, graft harvest duration, and graft length were analysed statistically between the groups. Results In groups 1 and 2, 18/30 (60%) and 19/30 (63%) of patients, respectively, developed sensory changes, with no significant difference between the groups (p = 0.79). Isolated SBSN and IPBSN paraesthesia occurred in 2/60 (3%) and 19/60 (32%), respectively. Combined SBSN and IPBSN paraesthesia was present in 16/60 (27%) of patients. There was no significant difference in the area of the sensory deficit between OI and IO groups on the 10th post-operative day or at 1-month, 3-month or 1-year follow-up (p = 0.723, p = 0.308, p = 0.478, p = 0.128, respectively). However, at 6-month follow-up, the area of paraesthesia was significantly higher in the IO group (p = 0.009). The length of incision and duration of graft harvest was higher in the OI group than in the IO group (p = 0.002 and p = 0.007, respectively), and the total length of the graft was greater in the IO group (p = 0.04). Conclusion Incidence is equally distributed, area of iatrogenic saphenous nerve injury gradually decreases, and recovery is seen in the majority of the patients in both graft harvest techniques. IO graft harvesting technique is better in terms of graft harvest time and cosmetics and yields longer graft; however, area of paraesthesia, though not significant, was two-fold higher than the OI technique at 1-year follow-up. Clinical relevance IO graft harvest technique would enable the surgeon to adopt quicker graft harvest, smaller surgical scar and lengthier graft than the OI technique. Level of evidence Therapeutic randomised controlled prospective study, Level II.

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“…Although many studies report the rate of SN injuries at a certain follow-up visit, the number of studies reporting consecutive follow-ups and recovery is very few [7,11,13,[16][17][18][22][23][24][25]. It is not easy to compare the data in these studies because the follow-up times vary, and different incisions and harvesting techniques are used.…”

Section: Rate Of Initial Injury and Recoverymentioning

confidence: 99%

The prognosis of iatrogenic saphenous nerve injuries during hamstring tendon harvesting in ACL reconstruction

EGERCI,

DOGRUOZ,

ASOGLU

et al. 2024

Preprint

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Purpose The purpose of this study was to evaluate the long-term prognosis of iatrogenic saphenous nerve (SN) injuries incurred during hamstring tendon harvesting for anterior cruciate ligament (ACL) reconstruction and their impact on clinical outcomes and patient satisfaction at least two years postoperatively. Materials and Methods A retrospective review was conducted on patients who underwent ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The study assessed the incidence of SN injuries immediately after surgery and at final follow-up, the recovery rate and time, and the impact of these injuries on functional outcomes using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. Results Out of 159 patients analyzed, iatrogenic SN injury was initially observed in 87 (54.7%) patients post-ACLR. At the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injury was noted in 51 (32.1%) patients, with varying involvement of the infrapatellar branch of the saphenous nerve (IPBSN) and the sartorial branch (SBSN). Patients with consistent SN injury reported a significant impact on daily activities and had lower LKS scores compared to those without injury or with recovered injury. A higher re-rupture rate was associated with persistent SN injury. Conclusions SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits at least two years postoperatively. These injuries can adversely affect patient satisfaction and functional outcomes and increase the re-rupture rate.

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A modified oblique incision in hamstring tendon graft harvesting during ACL reconstruction

Cited by 7 publications

References 30 publications

Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Outside-in technique versus inside-out semitendinosus graft harvest technique in ACLR: a randomised control trial

The prognosis of iatrogenic saphenous nerve injuries during hamstring tendon harvesting in ACL reconstruction

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