Saphenous nerve injury in ACL reconstruction: higher risk with dual hamstring harvest - an observational study

Injury to the saphenous nerve or its branches is one of the most common complications of Arthroscopic ACL reconstruction surgery. Among the various iatrogenic reasons for this injury, nerve injury during the passage of the tendon stripper (due to the anatomical proximity of the nerve to the tendons) has been reported already. This study compares the incidence of the saphenous nerve injury following isolated semitendinosus graft harvest versus combined semitendinosus and gracilis harvest during Arthroscopic ACL reconstruction.

A prospective observational study of 120 patients, who had undergone arthroscopic ACL reconstruction with semitendinosus graft alone (60 patients) and semitendinosus + gracilis graft (60 patients) from April 2020 to September 2023 was conducted. A follow-up regarding the presence of sensory changes in the saphenous nerve distribution was done at six months.

28.3% (17/60) of patients in the semitendinosus group (group A) had sustained sensory disturbances compared to 53.3% (32/60) of patients in the semitendinosus + gracilis group (group B). This difference was found to be statistically significant. However, the nerve injury did not interfere with the daily activities of the majority of patients.

The saphenous nerve is at a higher risk of injury during double hamstring graft harvesting. Surgeons may avoid resorting to double hamstring harvest whenever possible. Tripled or quadrupled semitendinosus is a viable option in most situations. Techniques like All inside ACLR with shorter graft lengths are worth considering in this context.