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Incision for an anteromedial portal with the knee flexed
6%
82/1403
Incision for an anteromedial portal with the knee extended
11%
155/1403
Incision for an accessory medial portal the with knee flexed
9%
130/1403
Hamstring harvest with the knee extended
70%
983/1403
Tibial tunnel aperture fixation with the knee at 30 degrees of flexion
3%
38/1403
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The saphenous nerve is most at risk during the hamstring harvest of an ACL reconstruction. At the joint line, the saphenous nerve is deep to the broad sartorious fascia, and superficial to the gracilis. Bertram et al describe a case report of a patient who sustained saphenous neuralgia following an ACL reconstruction utilizing a hamstring harvest. Symptoms can include paresthesias in the anteromedial region of the lower leg and tenderness at the medial side of the knee. They note that hip external rotation and knee flexion while harvesting the hamstring tendons allows the tendinous structures and saphenous nerve to relax, thus decreasing the chance of injury. Solman et al also stress the understanding of such anatomical relationships of the medial side of knee's anatomy to avoid pitfalls such as saphenous nerve injury during a hamstring harvest. Illustration A provides a depiction of the saphenous nerve with relation to the medial knee. Illustration B is an example of a cadaveric dissection showing the anatomic relationship of the saphenous nerve (black arrow) as it courses superficially along the sartorial fascia (labelled with S).
3.8
(22)
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