Abstract
Introduction
A common complication whilst harvesting the hamstring tendon in ACL reconstruction is injury to the infra-patellar branch of the saphenous nerve (IPBSN), resulting in altered sensation to the anterior and lateral aspects of the knee and leg.
Aim
The aim of this study was to understand the course of IPBSN in relation to tendon harvest in ACL reconstruction.
Material and method
The course of the nerve was traced and dissected in 14 pairs of cadaveric knees (10 male; 4 female) and four paths of IPBSN, in relation to the Sartorius muscle, were identified: (1) posterior - inferior posterior border of the muscle, (2) transmuscular, (3) anterior - anterior border of the muscle and (4) posterior patellar - posterior of the muscle at the level of the patellar.
Further 14 pairs of knees were dissected and hamstrings tendon harvested using either vertical and horizontal standard surgical incisions. A tendon harvesting stripper was used with the knee flexed at various angles (0, 45, and 90 degrees). The saphenous and ISBN was then dissected to observe for any damage.
Results
The posterior path (1 and 2) of ISBN was most common (57%) and at higher risk of being injured (90%), when using a stripper, due to the proximity of that pathway with the tendon of semintendinosus muscle. A vertical incision, 5cm from the midline, avoided damage to both nerves, compared to a horizontal incision.
Harvesting the tendons with the knee flexed at 90 degrees demonstrated to be the optimum angle of tendon harvest with minimal damage to IPBSN.
Conclusions
A posterior path IPBSN is more prone to damage during tendon harvest with a stripper. A vertical incision with a flexed knee gave the best method to harvest the tendon with minimal risk of damaging the infra-patellar branch and the saphenous nerve when using the tendon stripper.
