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


1 Orthopedics Surgery Department, Beheshti University of Medical Sciences , Tehran , IR Iran

2 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran


It was suggested that the direction of incision for medial hamstring tendons harvesting
influences the incidence of injury to the infrapatellar branch of the saphenous nerve
(IPBSN), a common complication following arthroscopically-assisted anterior cruciate
ligament reconstruction (ACLR).

The main purpose of current study was to compare the incidence of IPBSN injury between
vertical and oblique incisions utilizing electrophysiological evaluation.

Patients and Methods
There were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal
vertical or oblique incision groups, randomly. One year postoperatively, the patients
were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm
score was completed. The patients' satisfaction with surgical outcomes determined
utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect
of IPBSN injury on function and satisfaction was investigated.

The incidence of IPBSN injury was higher in the vertical group (4 patients vs. 10
patients), but the difference was not statistically significant. The mean of Lysholm and
VAS scores were the same. Also, the mean of Lysholm score was the same in patients with
and without IPBSN injury. However, patients without IPBSN injury were more satisfied
(8.9 ± 9 vs. 7.4 ± 1.1; P < 0.001).

IPBSN injury is a common complication following arthroscopically-assisted ACLR and, if
not significant, oblique direction of the incision is associated with decreased
incidence of the injury. IPBSN injury has no effect on the function but because of the
disturbance with patients' satisfaction, authors believe the oblique incision is
preferable to avoid the nerve injury during medial hamstring tendons harvesting.