Department of Orthopaedic Surgery and Sport Traumaotlogy, Grenoble South Teaching Hospital, Echirolles, France.
Department of Orthopaedic Surgery and Sport Traumaotlogy, Grenoble South Teaching Hospital, Echirolles, France.
Knee. 2020 Aug;27(4):1151-1157. doi: 10.1016/j.knee.2020.05.020. Epub 2020 Jun 25.
Injury to the infra-patellar branches of the saphenous nerve (IPBSN) is the main neurological complication of anterior cruciate ligament (ACL) reconstruction procedures. Surgical technique using quadriceps tendon (QT) autograft allows a less invasive tibial approach potentially protecting the IPBSN. The aim of this study was to compare the numbness surface of the cutaneous area supplied by the IPBSN after ACL reconstruction using either hamstring tendon (HT) or QT autografts.
This was a retrospective comparative cohort study including 51 patients who underwent ACL reconstruction (27 QT and 24 HT) between January 2017 and April 2018. A sensory clinical evaluation was performed on each patient: length of the tibial scar, eventual numbness surface area and the type of sensory disorder were reported. To be considered as an IPBSN lesion, the numbness area had to spread at least one-centimeter away from the scar.
The average follow-up was 15 months. In the HT group, the numbness area surface measured 21.2 ± 19 cm (0-77) and the scar length was on average 31.3 ± 5.6 mm. In the QT group, the numbness area was reduced to 5 ± 10 cm (P = .0007) as well as the scar length (13.3 ± 2.8 mm, P < .0001). We counted five (17.8%) and 19 (76%) real IPBSN lesions in the QT and HT groups, respectively (P = .0002). Hypoesthesia was the main sensory disorder observed (87.5%).
Numbness area of the cutaneous surface supplied by the IPBSN after ACL reconstruction is reduced using QT autograft compared with HT autograft.
隐神经髌下支（IPBSN）损伤是前交叉韧带（ACL）重建手术的主要神经并发症。使用股四头肌肌腱（QT）自体移植物的手术技术可采用对 IPBSN 潜在保护的胫骨微创入路。本研究的目的是比较使用腘绳肌腱（HT）或 QT 自体移植物重建 ACL 后 IPBSN 供应的皮肤区域麻木表面。
这是一项回顾性比较队列研究，纳入了 2017 年 1 月至 2018 年 4 月期间接受 ACL 重建的 51 例患者（27 例 QT 和 24 例 HT）。对每位患者进行了感觉临床评估：报告胫骨疤痕的长度、可能的麻木表面积和感觉障碍的类型。如果麻木面积至少离疤痕一厘米远，则被认为是 IPBSN 病变。
平均随访时间为 15 个月。在 HT 组，麻木面积为 21.2±19cm（0-77），疤痕长度平均为 31.3±5.6mm。在 QT 组，麻木面积缩小至 5±10cm（P=0.0007），疤痕长度也缩小至 13.3±2.8mm（P<0.0001）。我们在 QT 和 HT 组中分别计数了 5 例（17.8%）和 19 例（76%）真正的 IPBSN 病变（P=0.0002）。感觉迟钝是观察到的主要感觉障碍（87.5%）。
与 HT 自体移植物相比，QT 自体移植物重建 ACL 后 IPBSN 供应的皮肤表面麻木面积减小。
