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Autori: Nistor BM, Garofil DN, Ciolovan LM, Gabriel Dinu, Oancea F, Silivestru V
Editorial: I Holzapfel Munich, European Journal of Medical Research, Oct 2006, v. 11, Suppl II, p.136, 2006.
Tendon autografting has become the most successful procedure for ACL reconstruction.
Patellar tendon and Hamstrings tendons are the most common grafting choices. Anterior Knee Pain and injury to the infrapatellar branch of the saphenous nerve resulting in sensory disturbance have been described as the most frequent complications.
Patellar tendon graft harvesting can be performed with a single midline longitudinal incision technique, or with a two-transverse-incision technique.
Hamstrings tendons are harvested with a small vertical incision over the pes anserinus area.
The purpose of our study was to evaluate the incidence of anterior knee pain and sensory disturbance after the use of these different harvesting techniques.
198 single longitudinal incision Patellar Tendon, 127 two-transverse-incision Patellar Tendon and 275 Hamstrings tendons ACL reconstructions were performed between 2002 and 2005 in our department by the same surgeon (G. D.).
These series excluded patients with previous knee surgery, knee osteoarthritis, multiple ligament knee injuries and/or postoperative follow-up less than 4 months.
Patient records, arthroscopy and rehabilitation files and films were reviewed and analyzed.
We performed a descriptive analysis of these series of patients aiming to assess the incidence of most common complications.
On the basis of nerve distribution, sensory disturbance extending laterally beyond midline over the infrapatellar area was ascribed to injury to the infrapatellar branch of the saphenous nerve.
Donor-site discomfort, and inability to kneel or knee-walk at 4 months after surgery were ascribed to postoperative anterior knee pain.
Postoperative anterior knee pain was found in 67 patients (33.8%) from the Single Incision Patellar Tendon group, 23 patients (18%) from the Two-Transverse-Incision Patellar Tendon group, and 57 patients (20.7%) from the Hamstrings group.
Sensory disturbance due to infrapatellar nerve injury was found in 168 patients (84.8%) from the Single Incision Patellar Tendon group, 26 patients (20.4%) from the Two-Transverse-Incision Patellar Tendon group and 78 patients (28.3%) from the Hamstrings group.
The anatomic variations of the nerve branches preclude their absolute avoidance in any surgical incision.
The results of the study suggest that the two-transverse-incision approach of the patellar tendon offers a better chance of preserving the infrapatellar branch of the saphenous nerve, thus contributing to the prevention of postoperative anterior knee symptoms.
Avoiding these donor-site related complications can successfully contribute to a more efficient early knee rehabilitation in patients who undergo ACL reconstruction.
Cuvinte cheie: ACL plasty, nerve injuries, harvest site morbidity