Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction

Abstract

ObjectiveTo compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction.MethodsThirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2–14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale.ResultsThe total rate of dysesthesia was 42% (14 patients). Five patients (26%) on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients). On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%). No statistical differences between both groups were observed regarding patients’ weight, age, and height¸ as well as skin incision length.ConclusionPatients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.

Association between incision technique for hamstring tendon harvest in anterior cruciate ligament reconstruction and the risk of injury to the infra-patellar branch of the saphenous nerve: a meta-analysis

“…The clinical IPBSN deficit was defined as “hypoesthesia”, “dysesthesia” or “sensory disturbance”. Evaluations were performed using light touch [10, 13, 16], palpation [22], pin prick [25] or blunt needle [28]. One study used patient self‐assessment of the IPBSN injury [17] and one study performed an instrumental evaluation of IPBSN deficit with an electrophysiological study of sensory nerve potentials [30] (Tables 1, 2, 3).…”

“…Three studies [13, 16, 30] did not report significant differences between the two incisions, three studies [17, 25, 28] reported a significantly higher incidence of IPBSN injury in the case of vertical incision and one study [10] did not perform a statistical analysis that was sufficient in order to draw conclusions. When a fixed‐effect meta‐analysis of the three RCTs was performed, a significant RR of 2.39 ( p < 0.0001) was reported when a vertical incision was performed (Fig.…”

“…The present meta‐analysis has some limitations that warrant consideration. First, only three RCTs could be included [16, 25, 30]. These RCTs were, however, limited by factors such as an imprecise description of methods for randomization and concealment, with the possible effect of introducing bias.…”

“…The course of the branch at the pes anserinus puts it at substantial risk of damage when an incision is made to harvest HTs [12]. The direction in which the incision is made has, therefore, been the subject of investigation in relation to how the direction might affect the risk of iatrogenic IPBSN injury [10, 13, 16, 17, 22, 25, 28, 30]. However, no consensus has been reached in the attempts to determine the most appropriate incision, which might be relevant in order to reduce the risks of iatrogenic nerve injury and further optimize the outcomes offered by ACL reconstruction procedure.…”

Uma comparação entre incisões oblíquas e verticais na coleta do tendão dos isquiotibiais na reconstrução do LCA e na lesão do ramo infrapatelar do nervo safeno

“…6,7 Several investigations suggest the utilization of horizontal and oblique incisions to expose and harvest the tibial insertion of the hamstring tendons to reduce the damage to the IPBSN compared with vertical incisions; however, there is no consensus so far. 4,8 It has been articulated that the incisions with greater respect to the anatomy of the IPBSN could guarantee a lower complication rate. Subsequently, the present study aimed to compare the incidence of IPBSN injury between two different incisions, vertical and oblique, used for hamstring tendon graft harvest.…”