CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(03): 374-379
DOI: 10.1055/s-0039-1692695
Artigo Original
Tornozelo e pé
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve[*]

Article in several languages: português | English
Sohrab Keyhani
1   Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran
,
Seyyed Morteza Kazemi
1   Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran
,
Mohammadreza Minator Sajjadi
2   Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
,
1   Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran
3   Departamento Ortopédico, Tabriz University of Medical Sciences, Shohada Hospital, Tabriz, Iran
› Author Affiliations
Further Information

Publication History

21 March 2019

13 May 2019

Publication Date:
27 August 2019 (online)

Abstract

Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve.

Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded.

Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction.

Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

* Work developed at the Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran


 
  • Referências

  • 1 Evans S, Shaginaw J, Bartolozzi A. Acl reconstruction - it's all about timing. Int J Sports Phys Ther 2014; 9 (02) 268-273
  • 2 de Carvalho Júnior LH, Machado SLF, Gonçalves MBJ. , et al. Peri-incisional dysesthesia following anterior cruciate ligament reconstruction using central third of patellar tendon. Rev Bras Ortop 2015; 46 (01) 37-39
  • 3 Carneiro M, Navarro RD, Nakama GY, Barretto JM, Bessa de Queiroz AA, Malheiro Luzo MV. Arthroscopic double-bundle reconstruction of anterior cruciate ligament using hamstring tendon grafts: fixation with two interference screws. Rev Bras Ortop 2015; 44 (05) 441-445
  • 4 Gali JC, Resina AF, Pedro G. , et al. Importance of anatomically locating the infrapatellar branch of the saphenous nerve in reconstructing the anterior cruciate ligament using flexor tendons. Rev Bras Ortop 2014; 49 (06) 625-629
  • 5 Temponi E, Carvalho Júnior L, Soares L, Gonçalves M, Leite M, Silva Júnior O. Disestesia peri-incisional após reconstrução do ligamento cruzado anterior: comparação entre dois diferentes tipos de enxerto. Rev Port Ortop Traumatol 2013; 21 (03) 389-394
  • 6 Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C. Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 2008; 15 (05) 360-363
  • 7 Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I. 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 2006; 14 (08) 789-793
  • 8 Leite ML, Cunha FA, Costa BQ, Andrade RM, Diniz Junior JH, Temponi EF. Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction. Rev Bras Ortop 2016; 51 (06) 667-671
  • 9 Boon JM, Van Wyk MJ, Jordaan D. A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction. Surg Radiol Anat 2004; 26 (03) 167-171
  • 10 Brown Jr CH, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med 1993; 12 (04) 723-756
  • 11 Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 1991; 19 (05) 478-484
  • 12 Pagnani MJ, Warner JJ, O'Brien SJ, Warren RF. Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med 1993; 21 (04) 565-571
  • 13 Tifford CD, Spero L, Luke T, Plancher KD. The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study. Am J Sports Med 2000; 28 (04) 562-567
  • 14 Kalthur SG, Sumalatha S, Nair N, Pandey AK, Sequeria S, Shobha L. Anatomic study of infrapatellar branch of saphenous nerve in male cadavers. Ir J Med Sci 2015; 184 (01) 201-206
  • 15 Hunter LY, Louis DS, Ricciardi JR, O'Connor GA. The saphenous nerve: its course and importance in medial arthrotomy. Am J Sports Med 1979; 7 (04) 227-230
  • 16 Kerver AL, Leliveld MS, den Hartog D, Verhofstad MH, Kleinrensink GJ. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery. J Bone Joint Surg Am 2013; 95 (23) 2119-2125
  • 17 Tavakoli Darestani R, Bagherian Lemraski MM, Hosseinpour M, Kamrani-Rad A. 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 2013; 2 (03) 118-123
  • 18 Trescot AM, Brown MN, Karl HW. Infrapatellar saphenous neuralgia - diagnosis and treatment. Pain Physician 2013; 16 (03) E315-E324
  • 19 Portland GH, Martin D, Keene G, Menz T. Injury to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction: comparison of horizontal versus vertical harvest site incisions. Arthroscopy 2005; 21 (03) 281-285
  • 20 Letartre R, Isida R, Pommepuy T, Miletic B. Horizontal posterior hamstring harvest. Orthop Traumatol Surg Res 2014; 100 (08) 959-961
  • 21 de Padua VB, Nascimento PE, Silva SC, de Gusmão Canuto SM, Zuppi GN, de Carvalho SM. Saphenous nerve injury during harvesting of one or two hamstring tendons for anterior cruciate ligament reconstruction. Rev Bras Ortop 2015; 50 (05) 546-549