Impact of exploration of sensory branches of saphenous nerve in anterior cruciate ligament reconstructive surgery

Abstract

Background: Post-operative sensory disturbances following anterior cruciate ligament (ACL) reconstruction using the quadruple hamstring tendon is a prevalent complication. This study evaluates the impact of exploration and salvage of superficial branches of the saphenous nerve on the incidence of post-operative sensory loss.

Methods: In a prospective descriptive study, 98 out of 120 patients with ACL reconstruction operated by the transfix method were followed 2 weeks and 6 months post-surgery. Hamstring tendon autograft was harvested through a 2-3 cm anteromedial oblique incision just over the pes anserinus. Meticulous dissection was done to find and save the superficial sensory branches of the saphenous nerve through the incision. Sensory changes were evaluated by physical examination for light touch; patients were requested to complete a specific diagram to evaluate sensory loss.

Results: In 44 patients at least one nerve was located and saved. The rate of hypoesthesia in this group of patients was 20.5%. In 54 patients we were unable to locate the nerve. The rate of hyposthesia in this group was 72%, which was statistically significant (P < 0.005). The overall rate of sensory disturbance in 98 patients was 48.9%. A total of 10 patients developed hyposthesia over the anteromedial part of the Mid-leg.

Conclusion: Exploration and salvage of the sensory branches of the saphenous nerve has a tremendous effect on the rate of sensory deficit.