Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest

Sipahioğlu, Serkan; Zehir, Sinan; Sarıkaya, Baran; Levent, Ali

doi:10.1177/2309499017690995

Cited by 9 publications

(16 citation statements)

References 30 publications

(60 reference statements)

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“…However, recovery was reported to stop at the end of 1 year and paraesthesia became permanent [14]. Sipahioglu et al [20] and Spicer et al [22] reported high incidence of permanent nerve injury (80 and 50%, respectively) following graft harvest. However, in this study, six patients showed improvement of their sensory loss after 1 year of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size was calculated by the G*Power program, using priori statistical power analysis as performed with the percentage of sensory loss at 6 week duration as the primary outcome measure. As formerly evaluated by Sipahioglu et al [20], it can be predicted that up to 94 and 61% will suffer from sensory loss, after either technique, with alpha error of 5%, study power 95%, with the final sample size at least 41 per group. An independent sample t test was used for comparison between quantitative variables among the groups, while the Chi square test ( χ 2 ) was used to compare the qualitative variables among the groups.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Sharaby

Alfikey

Alhabsi

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Sharaby

Alfikey

Alhabsi

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…In recent years, most of the related studies that have been conducted have reported that regardless of the type incision that was selected, there were no statistically signi cant differences in postoperative functional scores. Most patients with abnormal sensation around the knee thought that their work and life would not be affected [18,24,25,26,27,28,30]. In this study, there was no signi cant difference in knee joint function or subjective feeling between the two incision groups.…”

Section: Discussionmentioning

confidence: 53%

“…It has been reported that the IPBSN is closely related to the location, type and direction of the incision [16]. In recent years, most studies have reported that oblique incisions are less likely to damage the IPBSN than are vertical and horizontal incisions, because according to autopsy studies, oblique incisions is more parallel and farther away from the IPBSN, so they are located in a safer area [18,24,25,26,27,28,30]. However, horizontal incisions easily lead to injury of the sartorius branch [22,23].…”

Section: Discussionmentioning

confidence: 99%

A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction

Zhu

Lou³

2020

Preprint

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Background: During anterior cruciate ligament(ACL)reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve(IPBSN). Most of recent studies in the literature suggest that the classic oblique incision(COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision(MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome.Methods: Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded. Results: At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups.Conclusion: The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.

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“…[ 24 ] reported an average area of sensory loss of 25 cm 2 , and Sipahioglu et al. [ 25 ] found that the area of hypoaesthesia was significantly higher in the group undergoing vertical skin incision (42.4 ± 22.3 cm 2 ) compared with oblique skin incision (9.3 ± 15.3 cm 2 ). Unlike their study, we compared the area of paraesthesia for graft harvest technique (OI versus IO technique) rather than skin incision.…”

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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Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest

Abstract: Oblique incision with less risk of nerve damage is better for graft harvesting. Area of hypaesthesia gradually reduces with time and even recover totally. As a possible complication, nerve injury and its benign prognosis should be explained to the patient before surgery.

Cited by 9 publications

References 30 publications

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

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

A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction

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

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