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Infrapatellar branch of saphenous nerve injury is a common complication following hamstring graft harvest during anterior cruciate ligament reconstruction.
As per this
study, the kind of incision has been reported to matter for the iatrogenic
nerve damage and in the routinely clinical damage. Also, there was lower rate
of neurological impairment embracing an oblique incision.
Infrapatellar
branch of saphenous nerve injury is a common complication following hamstring
graft harvest during anterior cruciate ligament reconstruction. The direction
of skin incision performed at proximal tibial metaphysis may affect the rate of
iatrogenic nerve damage. Aim of the present systematic review was to evaluate
evidence that would substantiate the adoption of one incision over another for
hamstring graft harvesting.
The available
literature was systematically screened searching studies dealing with
iatrogenic injury to the saphenous nerve after anterior cruciate ligament
reconstruction using hamstring tendons. A search was performed using the
keywords “Saphenous” and “Infrapatellar branch” in combination with “Anterior
cruciate ligament”, “arthroscopy” and “hamstrings”, supplying no limits regard
the publication year. Coleman methodological score was performed in all the
retained articles.
Five articles
matched the inclusion criteria. There were two randomized controlled trials,
one prospective comparative study and two retrospective comparative series.
Poor methodological quality was found overall. A vertical incision was found to
significantly affect the presence of hypoesthesia and the extent of the area of
sensory loss in three articles; no difference was registered in one, and a
trend towards a lower rate of iatrogenic nerve damage using an oblique incision
was found in the remaining one, without any statistical significance.
Although the low
methodological quality of the analyzed studies does not permit to draw
definitive conclusions, the anatomical course of the nerve along with the
results obtained in the available studies seems to suggest lower rate of
neurological impairment adopting an oblique incision. This kind of incision may
therefore be preferred in the routine clinical practice.
Knee Surg Sports Traumatol Arthrosc
Saphenous nerve injury during hamstring tendons harvest: Does the incision matter? A systematic review
A. Ruffilli et al.
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