Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions.

PURPOSE: To compare the incidence, extent of sensory loss, its clinical effect and natural course caused by three different skin incisions used for autogenous hamstring graft harvest during anterior cruciate ligament (ACL) reconstruction.

METHODS: One hundred and twenty patients who underwent hamstring graft harvest during ACL reconstruction, participated in the study. All patients were randomized into 3 groups as per the 3 incisions used-vertical, transverse and oblique. The area of sensory loss was documented as per anatomical distribution of the infrapatellar branch of saphenous nerve (IPSBN) and sartorial branch of sensory nerve (SBSN) at 6 weeks, 3 months and 6 months follow-ups. The length of incision, area of sensory loss and subjective pain score (out of 10) were also noted.

RESULTS: The incidence, area of hypesthesia and persistence at 6 months were significantly higher with vertical incision at all times, whereas it was the least with oblique incision. Injury to IPSBN was maximum with vertical incision (p = 0.000), and it was similar in the transverse and oblique incision groups. The SBSN injury incidence was not significantly different between the three groups (n.s.). Subjective cutaneous hypesthesia incidence was quite low in all the three groups. The oblique incision group had highest subjective satisfaction closely followed by the horizontal incision group.

CONCLUSIONS: Vertical incision has highest incidence of IPBSN injury, persistent hypesthesia, largest area of sensory loss and poorest subjective outcome. Oblique and transverse incision groups had statistically comparable results, though better outcome was noted in the oblique incision group. The SBSN injury was equally common in all the three incisions used. However, the sensory loss does not impair normal daily activities in the patients. We recommend use of oblique incision for hamstring graft harvest.

LEVEL OF EVIDENCE: Therapeutic randomized controlled prospective study, level I.