Injury to the Main Branch of the Saphenous Nerve following Hamstring Tendon Graft Harvesting: A Report of 3 Cases

Abstract

Background:

Hamstring tendon grafts are commonly utilized tendon autografts; however, the harvesting procedure can result in saphenous nerve injury due to its proximity to the semitendinosus and gracilis tendons. Injury to the main branch of the saphenous nerve is a less commonly reported and understood injury during these procedures.

Purpose:

This case report aimed to identify and present cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring tendon graft harvesting.

Methods:

A retrospective chart review of a tertiary-care hospital over the past 10 years was conducted. The search included clinical notes mentioning “saphenous neuropathy, neuralgia or neuritis” and magnetic resonance imaging (MRI) reports indicating saphenous nerve involvement. Patients with a history of a hamstring graft harvesting procedure and radiographically confirmed injury to the main branch of the saphenous nerve were included. Injury characteristics, symptoms, and sequential treatment were evaluated.

Results:

Three cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring graft harvesting were identified. Reported symptoms included pain, paresthesia, numbness, hypersensitivity, swelling, and discoloration. All 3 patients had persistent symptoms despite non-operative treatment and therefore underwent surgical intervention, which involved resection and reconstruction using allograft or burial into adjacent musculature. Postoperatively, 2 of 3 patients demonstrated resolution of symptoms.

Conclusion:

Iatrogenic injury to the main branch of the saphenous nerve is a complication that can occur during hamstring tendon harvesting procedures, leading to severe, persistent symptoms. A better understanding of the mechanism of injury is needed to minimize the risk of iatrogenic injury.

Keywords

nerve injury nerve knee lower extremity surgical approaches/techniques

Get full access to this article

View all access options for this article.

References

Bertram

Porsch

Hackenbroch

Terhaag

Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft. Arthroscopy. 2000;16(7):763–766. https://doi.org/10.1053/jars.2000.4820.

Bistolfi

Capella

Guidotti

, et al. Functional results of allograft vs. autograft tendons in anterior cruciate ligament (ACL) reconstruction at 10-year follow-up. Eur J Orthop Surg Traumatol Orthop Traumatol. 2021;31(4):729–735. https://doi.org/10.1007/s00590-020-02823-y.

Bottoni

Smith

Raybin

, et al. Autograft vs allograft ACL reconstructions: a prospective, randomized clinical study with minimum 10 year follow-up. Orthop J Sports Med. 2014;2(7 suppl.2):2325967114S0004. https://doi.org/10.1177/2325967114S00043.

Cody

Karnovsky

DeSandis

, et al. Hamstring autograft for foot and ankle applications. Foot Ankle Int. 2018;39(2):189–195. https://doi.org/10.1177/1071100717738220.

Dunaway

Steensen

Wiand

Dopirak

RM.

The sartorial branch of the saphenous nerve: its anatomy at the joint line of the knee. Arthroscopy. 2005;21(5):547–551. https://doi.org/10.1016/j.arthro.2005.02.019.

Hardy

Casabianca

Andrieu

Baverel

Noailles

Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: systematic review of literature. Orthop Traumatol Surg Res. 2017;103(8):S245–S248. https://doi.org/10.1016/j.otsr.2017.09.002.

Lin

Boyle

Marom

Marx

RG.

Graft selection in anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2020;28(2):41–48. https://doi.org/10.1097/JSA.0000000000000265.

Pagnani

Warner

JJP

O’Brien

Warren

RF.

Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med. 1993;21(4):565–571. https://doi.org/10.1177/036354659302100414.

Poehling

Pollock

Koman

LA.

Reflex sympathetic dystrophy of the knee after sensory nerve injury. Arthroscopy. 1988;4(1):31–35. https://doi.org/10.1016/S0749-8063(88)80008-2.

10.

Sanders

Rolf

McClelland

Xerogeanes

Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy. 2007;23(9):956–963. https://doi.org/10.1016/j.arthro.2007.03.099.

11.

Vinagre

Kennedy

Chahla

, et al. Hamstring graft preparation techniques for anterior cruciate ligament reconstruction. Arthrosc Tech. 2017;6(6):e2079–e2084. https://doi.org/10.1016/j.eats.2017.08.031.

12.

Walshaw

Karuppiah

Stewart

The course and distribution of the infra patellar nerve in relation to ACL reconstruction. Knee. 2015;22(5):384–388. https://doi.org/10.1016/j.knee.2014.11.003.

13.

Wisbech Vange

Tranum-Jensen

Krogsgaard

. Gracilis tendon harvest may lead to both incisional and non-incisional saphenous nerve injuries. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):969–974. https://doi.org/10.1007/s00167-019-05605-0.

14.

Zein

AMN

Ali

Zenhom Mahmoud

Omran

. Autogenous hamstring-bone graft preparation for anterior cruciate ligament reconstruction. Arthrosc Tech. 2017;6(4):e1253–e1262. https://doi.org/10.1016/j.eats.2017.04.01.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB