DOS 2016

DOS Kongressen 2016 ·

145

Several reasons for saphenous nerve injuries after

gracilis tendon harvesting. A cadaver study.

Signe Wisbech Vange

Dept. of Cellular and Molecular Medicine, The Panum Institute

Background:

Sensory loss in the saphenous nerve domain occurs in up to 74%

of patients undergoing ACL reconstruction using medial hamstring autografts.

It is well described that the nerve can be damaged during incision. The risk of

proximal nerve injury during tendon stripping has received less attention.

Purpose / Aim of Study:

The purpose was to examine where the saphenous

nerve is at risk during gracilis tendon harvesting. Semitendinosus tendon har-

vesting was not a focus due to the tendon`s distance from the saphenous nerve.

Materials and Methods:

In 17 cadaver limbs donated to the University of

Copenhagen the gracilis tendon was harvested according to standard routine.

The limbs were then carefully dissected exposing the saphenous nerve and its

branches to identify any injuries.

Findings / Results:

Dissections revealed a fascia separating the nerve from

the gracilis tendon. Lesions in the fascia were detected proximally to the incision

in 7 cases (41 %). Nerve injuries in relation to these lesions were observed in 5

cases (29 %). All were partial injuries on the main stem of the saphenous nerve

located superficially to the fascia, at the posterior border of the sartorius. Partial

or complete incisional injuries to the infrapatellar or medial cutaneous branches

were observed in 13 cases (76 %).

Conclusions:

The saphenous nerve is at risk in the incision area, but also in an

area proximally to the incision. The location of the proximal injuries suggests

they occurred during stripping of the tendon, and that they were caused either

by the Metzenbaum scissor used to release vinculae of the tendon or by the

stripper. We hypothesize that the Metzenbaum scissor is most likely to have

caused the observed injuries, and that blunt release of vinculae might lower the

risk of nerve injury.

No conflicts of interest reported

96.