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. 2018 Apr;26(4):1197-1203.
doi: 10.1007/s00167-017-4590-y. Epub 2017 Jun 1.

Oblique incisions in hamstring tendon harvesting reduce iatrogenic injuries to the infrapatellar branch of the saphenous nerve

Brandon Michael Henry  1   2 , Krzysztof A Tomaszewski  3   4 , Przemysław A Pękala  1   2 , Matthew J Graves  1   2 , Jakub R Pękala  1   2 , Beatrice Sanna  1   5 , Ewa Mizia  2
Affiliations

Oblique incisions in hamstring tendon harvesting reduce iatrogenic injuries to the infrapatellar branch of the saphenous nerve

Brandon Michael Henry et al. Knee Surg Sports Traumatol Arthrosc. 2018 Apr.

Abstract

Purpose: Iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus.

Methods: This study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury.

Results: The vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5-3.6) and 1.8 (95% 1.2-2.8), respectively.

Conclusions: The vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.

Keywords: ACL; Anterior cruciate ligament reconstruction; Cadaveric simulation; Hamstrings; IPBSN; Iatrogenic injury; Infrapatellar branch of the saphenous nerve; Tendon harvesting.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no competing interests.

Funding

Funding was provided by Jagiellonian University Statutory Funds. Krzysztof A. Tomaszewski was supported by the Foundation for Polish Science (FNP) and the Polish Ministry of Science and Higher Education scholarship for young scientists.

Ethical approval

The research protocol of this study has been approved by the bioethics committee of the Jagiellonian University Medical College Bioethics Committee (registry no KBET/317/B/2012). Cadaveric specimens used in this study were obtained from donations to the anatomy program of the affiliated institution, and permission was obtained for use. The study has been performed in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent not applicable to this study.

Figures

Fig. 1
Fig. 1
A dissected right limb showing the course of the IPBSN branching off the saphenous nerve. IPBSN infrapatellar branch of the saphenous nerve; PTL patella; SN saphenous nerve; and TT tibial tuberosity
Fig. 2
Fig. 2
Different techniques of incision during hamstring tendon harvesting (vertical, horizontal, and oblique). The incisions are indicated with red dashed lines on the anterior view of the right knee
See this image and copyright information in PMC

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