Posterior semitendinosus tendon harvesting minimizes the risk of injury to the infrapatellar and sartorial branches of the saphenous nerve

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure. Nowadays, there is a widespread use of the semitendinosus (ST) and gracilis (G) tendons (hamstrings) as autografts. ST and G tendons are harvested through an incision over the anteromedial aspect of the knee at the level of their insertion site at the pes anserinous. Several authors have reported an increased incidence of injury to the saphenous nerve itself, as well as to its two terminal branches, the infrapatellar (IBSN) and sartorial branch (SBSN), during ST and G tendon harvesting through the anterior approach. The IBSN supplies sensory innervation to the anteromedial aspect of the knee and the SBSN continues along the great saphenous vein to provide sensation to the medial aspect of the lower leg. Iatrogenic nerve damage may cause hypoesthesia, dysesthesia, painful neuroma, reflex sympathetic dystrophy, anterior knee pain and kneeling pain. Some investigators advocate that the size and orientation of the anterior skin incision for graft harvesting is responsible for the nerve injury (mainly to the IBSN), thus suggesting a small oblique skin incision. Others, however, believe that SBSN injury may be an intrinsic problem associated with blind, distal-to-proximal direction of G tendon harvesting and that the flexor tendons should be harvested with the knee placed in a “figure-four” position so as to relieve the pressure on the saphenous nerve. Despite these Abstract There are several reports of iatrogenic injury to the saphenous nerve branches during anterior cruciate ligament (ACL) reconstruction attributed to tendon harvesting through an anterior approach. Other investigators advocate that there is virtually no nerve damage when the tendons are harvested through a posteromedial knee incision. The aim of the present study was to compare the incidence of iatrogenic injury to the infrapatellar and sartorial branches of the saphenous nerve with anterior and posterior tendon harvesting. A prospective, randomized clinical study was conducted comparing patients treated with ACL reconstruction employing the conventional technique with a semitendinosus/gracilis autograft versus the all-inside technique with a short, quadrupled semitendinosus autograft. Tendon harvesting for these two groups was performed through the anterior and the posterior approach, respectively. Skin sensation of the anterior aspect of the operated knee and tibia was assessed by the pin prick test and was compared to the contralateral side. No sensory alterations were noted on the anteromedial aspect of the operated knee and tibia in patients of the posterior harvest group.