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.

The goal of this study is to evaluate the incidence rate of iatrogenic injuries to the infrapatellar branch(es) of saphenous nerve during ACL reconstruction with four-strand hamstring tendon autograft. Retrospective review of 226 patients that underwent 230 arthroscopically assisted primary ACL reconstructions with four-strand hamstring tendon autograft, between March 2002 and December 2004. The patients were separated into two groups. In group 1 (116 knees) the tendon was harvested and tibia prepared through a 3-cm vertical surgical incision (between March 2002 and September 2003) and in group 2 (114 knees) through a 3-cm horizontal surgical incision (between October 2003 and December 2004). In group 1, we found 39.7% of the patients with disturbed sensitivity in the area of the infrapatellar branch(es) of the saphenous nerve distribution. In patients of group 2 the incidence of nerve injury was 14.9% (P<0.001). The horizontal surgical incision in harvesting hamstrings tendon autograft for ACL reconstruction was found to have less associated chance of iatrogenic injury to the infrapatellar branch(es) of the saphenous nerve. No technical ties were found in both incisions for graft harvest.