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Research article
A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction
Biao Zhu
Tengzhou Central People's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8423-2447
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: During anterior cruciate ligament(ACL)reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve(IPBSN). Most of recent studies in the literature suggest that the classic oblique incision(COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision(MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome.
Methods: Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded.
Results: At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups.
Conclusion: The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.
Keywords
anterior cruciate ligament, inferior patellar branch of saphenous nerve, hamstring tendon
Figure 1
Figure 1
Figure 1
Due to technical limitations, table 1 is only available as a download in the Supplemental Files section.
Table 2. Outcomes of incision surgery by group.
|
|
COI N=30 |
MOI N=32 |
P value |
|
Number of patients with numbness |
|
|
|
|
2th week (%) |
40.0% |
15.6% |
＜0.05 |
|
1 year (%) |
33.3% |
9.4% |
＜0.05 |
|
Area of sensory loss (mean + SD) cm2 |
|
|
|
|
2th week (%) |
42.1±3.5 |
17.3±2.6 |
＜0.05 |
|
1 year (%) |
26.4±2.4 |
9.8±3.4 |
＜0.05 |
|
Incision length (mean±SD)cm
|
3.1±0.87 |
2.9 ± 0.85 |
＞0.05 |
|
Lysholm knee score 1 year (%) IKDC subjective assessmen |
93
95 |
94 97 |
＞0.05 ＞0.05 |
|
1 year (%) |
|||
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CURRENT STATUS: Under Revision
Version 1
Posted 18 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 10 Jan, 2021
Review #2 received
Received 27 Dec, 2020
Reviewer #3 agreed
On 27 Dec, 2020
Review #3 received
Received 27 Dec, 2020
Reviewer #2 agreed
On 25 Dec, 2020
Reviewer #1 agreed
On 22 Dec, 2020
Review #1 received
Received 22 Dec, 2020
Reviewers invited
Invitations sent on 21 Dec, 2020
Editor assigned
On 08 Dec, 2020
Submission checks complete
On 08 Dec, 2020
Editor invited
On 08 Dec, 2020
First submitted
On 02 Dec, 2020
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Subject Areas
Orthopedic Surgery
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This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction
Biao Zhu
Tengzhou Central People's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8423-2447
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 18 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 10 Jan, 2021
Review #2 received
Received 27 Dec, 2020
Reviewer #3 agreed
On 27 Dec, 2020
Review #3 received
Received 27 Dec, 2020
Reviewer #2 agreed
On 25 Dec, 2020
Reviewer #1 agreed
On 22 Dec, 2020
Review #1 received
Received 22 Dec, 2020
Reviewers invited
Invitations sent on 21 Dec, 2020
Editor assigned
On 08 Dec, 2020
Submission checks complete
On 08 Dec, 2020
Editor invited
On 08 Dec, 2020
First submitted
On 02 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: During anterior cruciate ligament(ACL)reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve(IPBSN). Most of recent studies in the literature suggest that the classic oblique incision(COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision(MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome.
Methods: Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded.
Results: At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups.
Conclusion: The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.
Figure 1
Figure 1
Figure 1
Due to technical limitations, table 1 is only available as a download in the Supplemental Files section.
Table 2. Outcomes of incision surgery by group.
|
|
COI N=30 |
MOI N=32 |
P value |
|
Number of patients with numbness |
|
|
|
|
2th week (%) |
40.0% |
15.6% |
＜0.05 |
|
1 year (%) |
33.3% |
9.4% |
＜0.05 |
|
Area of sensory loss (mean + SD) cm2 |
|
|
|
|
2th week (%) |
42.1±3.5 |
17.3±2.6 |
＜0.05 |
|
1 year (%) |
26.4±2.4 |
9.8±3.4 |
＜0.05 |
|
Incision length (mean±SD)cm
|
3.1±0.87 |
2.9 ± 0.85 |
＞0.05 |
|
Lysholm knee score 1 year (%) IKDC subjective assessmen |
93
95 |
94 97 |
＞0.05 ＞0.05 |
|
1 year (%) |
|||