Journal of ISAKOS : joint disorders & orthopaedic sports medicine · 2024
Oblique or short incisions reduce the risk of saphenous nerve damage during hamstrings harvesting: A model for mapping nerve pathways at the harvest site.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Vermorel Pierre-Henri, Stordeur Alban, Grange Sylvain, Klasan Antonio, Philippot Rémi, Neri Thomas
Аннотация
INTRODUCTION: Hamstring autografts are frequently used for ligament reconstruction surgery. Between 12% and 84% of patients report hypoesthesia or dysaesthesia secondary to injury of the saphenous nerve or one of its branches after hamstring harvesting. Type of incision (orientation and length) is subject of much regarding limiting the risk of nerve damage. A cadaveric study was performed to determine which type of incision limits the risk of injury to the saphenous nerve or one of its branches, based on an anatomic model for mapping nerve pathways at the harvest site.
METHODS: An anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modeled for three lengths (2, 3, and 4 cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a 'low-collision-risk' safe zone was identified.
RESULTS: Nerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4 cm (p < 0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage.
CONCLUSION: This cadaveric study suggests that during hamstring harvesting, incisions shorter than 2 cm reduce the risk of saphenous nerve's branches injuries. For incisions longer than 2 cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions.
LEVEL OF EVIDENCE: Level of evidence not applicable: Laboratory experiments.
METHODS: An anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modeled for three lengths (2, 3, and 4 cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a 'low-collision-risk' safe zone was identified.
RESULTS: Nerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4 cm (p < 0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage.
CONCLUSION: This cadaveric study suggests that during hamstring harvesting, incisions shorter than 2 cm reduce the risk of saphenous nerve's branches injuries. For incisions longer than 2 cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions.
LEVEL OF EVIDENCE: Level of evidence not applicable: Laboratory experiments.