Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2017

23.06.2016 | Knee

Saphenous nerve injury during hamstring tendons harvest: Does the incision matter? A systematic review

verfasst von: A. Ruffilli, M. De Fine, F. Traina, F. Pilla, D. Fenga, C. Faldini

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

Although the low methodological quality of the analysed 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.

Level of evidence

Systematic review, Level II.
Literatur
1.
Zurück zum Zitat Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144CrossRefPubMed Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144CrossRefPubMed
2.
Zurück zum Zitat Arthornthurasook A, Gaew-Im K (1990) The sartorial nerve: its relationship to the medial aspect of the knee. Am J Sports Med 18:41–42CrossRefPubMed Arthornthurasook A, Gaew-Im K (1990) The sartorial nerve: its relationship to the medial aspect of the knee. Am J Sports Med 18:41–42CrossRefPubMed
3.
Zurück zum Zitat Boon JM, Van Wyk MJ, Jordaan D (2004) A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction. Surg Radiol Anat 26:167–171CrossRefPubMed Boon JM, Van Wyk MJ, Jordaan D (2004) A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction. Surg Radiol Anat 26:167–171CrossRefPubMed
4.
Zurück zum Zitat Buda R, Ruffilli A, Vannini F, Parma A, Giannini S (2013) Anatomic anterior cruciate ligament reconstruction using distally inserted doubled hamstrings tendons. Orthopedics 36:449–453CrossRefPubMed Buda R, Ruffilli A, Vannini F, Parma A, Giannini S (2013) Anatomic anterior cruciate ligament reconstruction using distally inserted doubled hamstrings tendons. Orthopedics 36:449–453CrossRefPubMed
5.
Zurück zum Zitat Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11CrossRefPubMed Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11CrossRefPubMed
6.
Zurück zum Zitat Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C (2008) Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 15:360–363CrossRefPubMed Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C (2008) Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 15:360–363CrossRefPubMed
7.
Zurück zum Zitat Figueroa D, Calvo R, Vaisman A, Carrasco MA, Moraga C, Delgado I (2007) Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings. Arthroscopy 23:312–315CrossRefPubMed Figueroa D, Calvo R, Vaisman A, Carrasco MA, Moraga C, Delgado I (2007) Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings. Arthroscopy 23:312–315CrossRefPubMed
8.
Zurück zum Zitat Franz W, Baumann A (2016) Minimally invasive semitendinosus tendon harvesting from the popliteal fossa versus conventional hamstring tendon harvesting for ACL reconstruction: A prospective, randomised controlled trial in 100 patients. The Knee Epub ahead of print Franz W, Baumann A (2016) Minimally invasive semitendinosus tendon harvesting from the popliteal fossa versus conventional hamstring tendon harvesting for ACL reconstruction: A prospective, randomised controlled trial in 100 patients. The Knee Epub ahead of print
9.
Zurück zum Zitat Hunter LY, Louis DS, Ricciardi JR, O’Connor GA (1979) The saphenous nerve: its course and importance in medial arthrotomy. Am J Sports Med 7:227–230CrossRefPubMed Hunter LY, Louis DS, Ricciardi JR, O’Connor GA (1979) The saphenous nerve: its course and importance in medial arthrotomy. Am J Sports Med 7:227–230CrossRefPubMed
10.
Zurück zum Zitat Jameson S, Emmerson K (2007) Altered sensation over the lower leg following hamstring graft anterior cruciate ligament reconstruction with transverse femoral fixation. Knee 14:314–320CrossRefPubMed Jameson S, Emmerson K (2007) Altered sensation over the lower leg following hamstring graft anterior cruciate ligament reconstruction with transverse femoral fixation. Knee 14:314–320CrossRefPubMed
11.
Zurück zum Zitat Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980CrossRefPubMed Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980CrossRefPubMed
12.
Zurück zum Zitat Kjaergaard J, Faunø LZ, Faunø P (2008) Sensibility loss after ACL reconstruction with hamstring graft. Int J Sports Med 29:507–511CrossRefPubMed Kjaergaard J, Faunø LZ, Faunø P (2008) Sensibility loss after ACL reconstruction with hamstring graft. Int J Sports Med 29:507–511CrossRefPubMed
13.
Zurück zum Zitat Luo H, Yu J, Ao Y, Yu C, Peng L-B, Lin C, Zhang J, Fu X (2007) Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl) 120:1127–1130 Luo H, Yu J, Ao Y, Yu C, Peng L-B, Lin C, Zhang J, Fu X (2007) Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl) 120:1127–1130
14.
Zurück zum Zitat Mirzatolooei F, Pisoodeh K (2012) Impact of exploration of sensory branches of saphenous nerve in anterior cruciate ligament reconstructive surgery. Arch Iran Med 15:219–222PubMed Mirzatolooei F, Pisoodeh K (2012) Impact of exploration of sensory branches of saphenous nerve in anterior cruciate ligament reconstructive surgery. Arch Iran Med 15:219–222PubMed
15.
Zurück zum Zitat Mochizuki T, Akita K, Muneta T, Sato T (2003) Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons. Surg Radiol Anat 25:192–199CrossRefPubMed Mochizuki T, Akita K, Muneta T, Sato T (2003) Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons. Surg Radiol Anat 25:192–199CrossRefPubMed
16.
Zurück zum Zitat Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2006) Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793CrossRefPubMed Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2006) Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793CrossRefPubMed
17.
Zurück zum Zitat Ruffilli A, Traina F, Evangelisti G, Borghi R, Perna F, Faldini C (2015) Preservation of hamstring tibial insertion in anterior cruciate ligament reconstruction: a review of the current literature. Musculoskelet Surg 99:87–92CrossRefPubMed Ruffilli A, Traina F, Evangelisti G, Borghi R, Perna F, Faldini C (2015) Preservation of hamstring tibial insertion in anterior cruciate ligament reconstruction: a review of the current literature. Musculoskelet Surg 99:87–92CrossRefPubMed
18.
Zurück zum Zitat Sabat D, Kumar V (2013) Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions. Knee Surg Sports Traumatol Arthrosc 21:2089–2095CrossRefPubMed Sabat D, Kumar V (2013) Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions. Knee Surg Sports Traumatol Arthrosc 21:2089–2095CrossRefPubMed
19.
Zurück zum Zitat Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963CrossRefPubMed Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963CrossRefPubMed
20.
Zurück zum Zitat Spicer DD, Blagg SE, Unwin AJ, Allum RL (2000) Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:286–289CrossRefPubMed Spicer DD, Blagg SE, Unwin AJ, Allum RL (2000) Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:286–289CrossRefPubMed
21.
Zurück zum Zitat Tavakoli Darestani R, Bagherian Lemraski MM, Hosseinpour M, Kamrani-Rad A (2013) Electrophysiological assessment of injury to the infra-patellar branch(es) of the saphenous nerve during anterior cruciate ligament reconstruction using medial hamstring auto-grafts: vertical versus oblique harvest site incisions. Arch Trauma Res 2:118–123PubMedPubMedCentral Tavakoli Darestani R, Bagherian Lemraski MM, Hosseinpour M, Kamrani-Rad A (2013) Electrophysiological assessment of injury to the infra-patellar branch(es) of the saphenous nerve during anterior cruciate ligament reconstruction using medial hamstring auto-grafts: vertical versus oblique harvest site incisions. Arch Trauma Res 2:118–123PubMedPubMedCentral
22.
Zurück zum Zitat Walshaw T, Karuppiah SV, Stewart I (2015) The course and distribution of the infra patellar nerve in relation to ACL reconstruction. Knee 22:384–388CrossRefPubMed Walshaw T, Karuppiah SV, Stewart I (2015) The course and distribution of the infra patellar nerve in relation to ACL reconstruction. Knee 22:384–388CrossRefPubMed
23.
Zurück zum Zitat Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61:56–62CrossRefPubMed Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61:56–62CrossRefPubMed
24.
Zurück zum Zitat Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714CrossRefPubMed Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714CrossRefPubMed
Metadaten
Titel
Saphenous nerve injury during hamstring tendons harvest: Does the incision matter? A systematic review
verfasst von
A. Ruffilli
M. De Fine
F. Traina
F. Pilla
D. Fenga
C. Faldini
Publikationsdatum
23.06.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2017
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4217-8

Weitere Artikel der Ausgabe 10/2017

Knee Surgery, Sports Traumatology, Arthroscopy 10/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.