Purpose: Damage to the infrapatellar branch of the saphenous nerve and subsequent loss of sensation following graft harvest in ACL reconstruction is common. An oblique incision, rather than a vertical incision, has been shown to reduce the incidence and area of sensory loss following graft harvest [1] although the results are not universal. The purpose of this study was to determine if there was a difference in the area of infrapatellar neuritis (IFPN) and quality of life (QOL) between ACL patients that received a vertical – (VI) versus oblique-incision (OI) for hamstring tendon harvest.

Method: An interim analysis of a single-blinded randomized controlled trial (N=100) was conducted. Patients with clinical – and/or MRI-evidence of an ACL tear and no previous injury to the knee or surrounding soft tissues (including skin) were consented. Participants completed an ACL-QOL questionnaire pre-operatively, were randomized intra-operatively, and returned for follow-up at 1.5-, 6-, 12 – and 24-months to trace altered area of skin sensation and complete an ACL-QOL questionnaire. The area of altered skin sensation was quantified with ImageJ (NIH) software. The intention-to-treat principle was applied and a student’s t-test was used for statistical analysis. (p< .05).

Results: An interim analysis of 25 patients with a follow-up of 6 – to 24-mo demonstrated that the VI group (79.1 ± 15.6 cm2) had a greater affected area than the OI group (10.9 ± 3.5 cm2), no difference in ACL-QOL scores was evident.

Conclusion: Based on the difference in morbidity between the two groups, and similar results in a previous study (2), OI incision for graft harvest is recommended.

Introduction Morbidity associated with wound complications may translate into disability and quality-of-life disadvantages for patients treated with radiotherapy (RT) for soft tissue sarcoma (STS) of the extremities. Functional outcome and health status of extremity STS patients randomized in a phase III trial comparing pre-operative versus post-operative RT is described.

Methods One hundred and ninety patients with extremity STS were randomized after stratification by tumor size dichotomized at 10 cm. Function and quality of life were measured by the Musculoskeletal Tumor Society Rating Scale (MSTS), the Toronto Extremity Salvage Score (TESS), and the Short Form-36 (SF-36) at randomization, six weeks, and three, six, 12, and 24 months after surgery. One hundred and eighty-five patients had function data.

Results Patients treated with post-operative RT had better function with higher MSTS (25.8 v 21.3, P < .01), TESS (69.8 v 60.6, P =.01), and SF-36 bodily pain (67.7 v 58.5, P =.03) scores at six weeks after surgery. There were no differences at later time points. Scores on the physical function, role-physical, and general health sub-scales of the SF-36 were significantly lower than Canadian normative data at all time points. After treatment arm was controlled for, MSTS change scores were predicted by a lower-extremity tumor, a large resection specimen, and motor nerve sacrifice; TESS change scores were predicted by lower-extremity tumor and prior incomplete excision. When wound complication was included in the model, patients with complications had lower MSTS and TESS scores in the first two years after treatment.

Conclusions The timing of RT has minimal impact on the function of STS patients in the first year after surgery. Tumor characteristics and wound complications have a detrimental effect on patient function.