Haviv Barak, Bronak Shlomo, Rath Ehud, Yassin Mustafa
Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel; Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Israel; Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel.
Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel; Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel.
Knee. 2017 Jun;24(3):564-569. doi: 10.1016/j.knee.2017.03.009. Epub 2017 Apr 9.
Tendon harvesting for anterior cruciate ligament reconstruction often injures sensory branches of the saphenous nerve. The reports on the prevalence of these injuries are scarce, while the implications on patient satisfaction are not known. Our objective was to compare the prevalence of sensory nerve injuries in patellar to hamstring autograft harvesting for anterior cruciate ligament reconstructions and follow up their postoperative course.
Between 2012 and 2014, patients who had a primary anterior cruciate ligament reconstruction with bone patellar tendon bone or hamstring autografts were included (n=94). We evaluated and compared demographic details, level of activity and postoperative sensation disturbances between both groups. Data was analyzed retrospectively.
The mean postoperative follow-up time was 23months. At the last follow-up 46 (77%) patients of the patellar tendon group and 22 (58%) of the hamstring tendons group reported on reduced sensation; however, in both groups a quarter of these patients experienced full recovery within an average of seven to eight months. There were more patients in the hamstring tendons group that reported on partial recovery. In most cases midline incisions for patellar tendons harvesting injured the infrapatellar branch and medial incisions for hamstring tendons harvesting injured the sartorial branch of the saphenous nerve.
Harvesting tendon autografts for anterior cruciate ligament reconstructions by vertical incisions had high prevalence of saphenous nerve branches injury with a minor possibility for complete recovery within the first year. The loss of sensation was perceived by patients as a minor complication.
Level IV, therapeutic case series.
用于前交叉韧带重建的肌腱取材常常会损伤隐神经的感觉分支。关于这些损伤发生率的报道较少，且对患者满意度的影响尚不清楚。我们的目的是比较髌腱与腘绳肌自体肌腱取材用于前交叉韧带重建时感觉神经损伤的发生率，并随访其术后病程。
纳入2012年至2014年间接受初次前交叉韧带重建且采用骨-髌腱-骨或腘绳肌自体肌腱的患者（n = 94）。我们评估并比较了两组患者的人口统计学细节、活动水平及术后感觉障碍情况。对数据进行回顾性分析。
术后平均随访时间为23个月。在末次随访时，髌腱组46例（77%）患者和腘绳肌组22例（58%）患者报告感觉减退；然而，两组中均有四分之一的此类患者在平均7至8个月内完全恢复。腘绳肌组报告部分恢复的患者更多。在大多数情况下，髌腱取材的中线切口损伤髌下支，腘绳肌取材的内侧切口损伤隐神经的缝匠肌支。
通过垂直切口取材自体肌腱用于前交叉韧带重建时，隐神经分支损伤的发生率较高，且在第一年内完全恢复的可能性较小。患者将感觉丧失视为一种轻微并发症。
IV级，治疗性病例系列。
