Explore the vast range of titles available.

PurposeOur study aimed to illustrate the positional relationship of the two branches of the saphenous nerve: the infrapatellar branch of the saphenous nerve (IPBSN) and medial crural cutaneous nerve (MCCN), as well as the anatomical landmarks using high-resolution ultrasound (HRUS) to help prevent iatrogenic nerve injury.MethodsWe used HRUS to explore the positional relationships among the anatomical landmarks, IPBSN, and MCCN in 40 knees of 20 participants. The distances from these branches to key reference points were recorded. Using the ultrasound caliper mode, we measured the depth from the skin surface to the nerves at four distinct points.ResultsThe average distances between IPBSN and medial border of patella (MBP) and IPBSN and medial border of patellar ligament (MBPL) were 47 ± 7 mm and 42 ± 9 mm, respectively. MCCN showed mean distances of 94 ± 9 mm and 96 ± 9 mm to MBP and MBPL, respectively. The mean distance from the upper edge of pes anserine to IPBSN at the patellar apex (PA) level was 24 ± 10 mm and to MCCN was 34 ± 9 mm.ConclusionWe used high-resolution ultrasound to evaluate IPBSN and MCCN and their positions relative to anatomical landmarks. The study results offer valuable insights into the course of these nerves, which can help establish a safety zone to prevent accidental nerve injuries during knee surgeries and injections.

Purpose of Review The infrapatellar branch of the saphenous nerve (IPS) is an under-investigated nerve that can be a source of chronic knee pain. This literature review aims to deliver an up-to-date review of chronic pain transmitted via the IPS along with therapeutic approaches available for pain refractory to conservative measures. Recent Findings Knee pain transmitted via the IPS can arise from several etiologies. Damage to the IPS is often iatrogenic and develops following total knee arthroplasty, anterior cruciate ligament reconstruction, and other knee surgical procedures. Other causes of IPS-derived pain include entrapment of the nerve, neuromas, Schwannomas, and pain from knee osteoarthritis transmitted through the IPS.This article investigated therapeutic approaches to pain derived from the IPS. Common approaches included radiofrequency ablation, neuroma excisions, Schwannoma excision, nerve blocks, surgical exploration, surgical release of an entrapped nerve, cryoablation, and peripheral nerve stimulation. Pain scores, duration of pain relief, adverse events, and secondary outcomes were all included in this review. Summary A subset of the patient population experiences chronic pain deriving from the IPS that is refractory to conservative treatment measures. This review aims to evaluate the etiologies and therapeutic approaches for chronic pain arising from the IPS refractory to conservative treatments.

PurposeThe saphenous nerve is a predominantly sensory nerve. It is the longest nerve of the body which supplies the skin of the medial side of the leg and foot as far as the ball of the great toe. We present here an unusual motor branch of the saphenous nerve to the sartorius muscle.MethodInstitutional guidelines for use of human cadaver were followed. Routine dissection of the lower limbs for undergraduate medical teaching was performed in a 67 years old female cadaver employing standard methods. Relevant gross features of the variations were photographed. H&E staining of relevant structure was done and photomicrographed.ResultsThe unusual motor branch to Sartorius was observed in the right thigh. The branch was given off in the lower third of the thigh after the saphenous nerve exited the adductor canal. The branch was distinctly seen entering the substance of the sartorius. The structure was confirmed to be a peripheral nerve by histological examination. The saphenous nerve then descended between the sartorius and gracilis tendons, pierced the fascia lata and became cutaneous.ConclusionThe motor branch to the sartorius muscle is a very rare branch whose knowledge is important for clinicians as it can get damaged during arthroscopy and other knee surgery or during adductor canal block.

Purpose Infrapatellar branch of saphenous nerve injury is a common complication following hamstring graft harvest during anterior cruciate ligament reconstruction. The direction of skin incision performed at proximal tibial metaphysis may affect the rate of iatrogenic nerve damage. Aim of the present systematic review was to evaluate evidence that would substantiate the adoption of one incision over another for hamstring graft harvesting. Methods The available literature was systematically screened searching studies dealing with iatrogenic injury to the saphenous nerve after anterior cruciate ligament reconstruction using hamstring tendons. A search was performed using the keywords “Saphenous” and “Infrapatellar branch” in combination with “Anterior cruciate ligament”, “arthroscopy” and “hamstrings”, supplying no limits regard the publication year. Coleman methodological score was performed in all the retained articles. Results Five articles matched the inclusion criteria. There were two randomized controlled trials, one prospective comparative study and two retrospective comparative series. Poor methodological quality was found overall. A vertical incision was found to significantly affect the presence of hypoesthesia and the extent of the area of sensory loss in three articles; no difference was registered in one, and a trend towards a lower rate of iatrogenic nerve damage using an oblique incision was found in the remaining one, without any statistical significance. Conclusion Although the low methodological quality of the analysed studies does not permit to draw definitive conclusions, the anatomical course of the nerve along with the results obtained in the available studies seems to suggest lower rate of neurological impairment adopting an oblique incision. This kind of incision may therefore be preferred in the routine clinical practice. Level of evidence Systematic review, Level II.

The sartorius muscle belongs to the anterior compartment of the thigh. Morphological variations of this muscle are very rare, few cases being described in the literature. An 88-year-old female cadaver was dissected routinely for research and teaching purposes. However, an interesting variation was found during anatomical dissection. The proximal part of the sartorius muscle had the normal course, but the distal part bifurcated into two muscle bellies. The additional head passed mediallyto the standard head; thereafter, there was a muscular connection between them. This connection then passed into the tendinous distal attachment. It created a pes anserinus superficialis, which was located superficially to the distal attachments of the semitendinosus and gracilis muscles. This superficial layer was very wide and attached to the medial part of the tibial tuberosity and to the crural fascia. Importantly, two cutaneous branches of the saphenous nerve passed between the two heads. The two heads were innervated by separate muscular branches of the femoral nerve. Such morphological variability could be clinically important.

Purpose The purpose of this study was to map saphenous nerve injuries after gracilis tendon harvest, with the aim of contributing knowledge that makes it possible to prevent these injuries. Methods Twenty-two cadaver limbs were used. Three were dissected to examine fascial structures between the saphenous nerve and the gracilis tendon. In 19 limbs, the gracilis tendon was harvested according to standard operative routine. The saphenous nerve was subsequently exposed by dissection and injuries were recorded. Results A well-defined sub-sartorial fascial layer separated the saphenous nerve from the gracilis tendon. Incisional injuries involving either a medial cutaneous crural branch or the infrapatellar branch were found in 14 of the 19 cases. Non-incisional injuries affecting the sartorial branch of the saphenous nerve (to conform to most surgical literature, we use the term 'sartorial branch' to denote the continuation of the saphenous nerve after departure of the infrapatellar branch) were found in six cases located 5–8 cm proximal and posterior to the gracilis tendon insertion on tibia. The fascia separating the saphenous nerve from the gracilis tendon had been perforated in relation to all non-incisional injuries. Conclusions Small subcutaneous branches of the saphenous nerve are at risk of injury from the incision, while the sartorial branch is at risk outside the incision area. Descriptions of the location of non-incisional injuries have not been published before and are of clinical relevance, as they can contribute to the prevention of saphenous nerve injuries during gracilis tendon harvest.

Purpose Iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus. Methods This study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury. Results The vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5–3.6) and 1.8 (95% 1.2–2.8), respectively. Conclusions The vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.

BackgroundThe potential of ultrasound-guided labelling of the inferior patellar branch of the saphenous nerve (IPBSN) to reduce IPBSN injury during anterior cruciate ligament reconstruction (ACLR) has not been explored. The primary objective of this retrospective cohort analysis was to assess whether intraoperative hamstring tendon harvesting avoiding the marked IPBSN would be effective in reducing the incidence of postoperative skin sensory disturbances and the mean area of sensory disturbances.Methods and analysisA retrospective cohort study involving 60 patients who underwent autograft ACLR at Yichang Central People’s Hospital from October 2020 to October 2024 was conducted. Patients were divided into two groups on the basis of the use of preoperative ultrasound localization of the IPBSN, including the nonultrasound localization group (control group) and the ultrasound localization group (experimental group), with 30 patients in each group. The control group underwent standard ACLR with a diagonal incision for hamstring tendon harvesting, whereas the experimental group underwent preoperative ultrasound-guided localization of the IPBSN to avoid the nerve during incision. The primary outcome measures include the incidence of skin sensory disturbances and the average sensory disturbance area. The secondary outcomes include the Lysholm score and VAS score at the 6-month postoperative follow-up.ResultsThe incidence of skin sensory disturbances in the experimental group was lower than that in the control group, and the average area of sensory disturbance was smaller in the experimental group (P < 0.05). At the 6-month postoperative follow-up, no statistically significant differences in the Lysholm knee scores or visual analogue scale (VAS) pain scores were noted between the two groups (P > 0.05).ConclusionPreoperative ultrasound-guided localization of the IPBSN can reduce the risk of nerve injury during ACLR. The ultrasound-guided approach leads to a lower incidence of sensory disturbances and a smaller average area of sensory disturbance. IPBSN injury was not related to anterior knee pain or knee ROM limitations. Patients can choose whether to use ultrasound localization before surgery according to their needs. The study protocol adhered to strict standards of ethical conduct and patient safety. The results of this trial are expected to provide valuable insights into the prevention of injury to the IPBSN during hamstring tendon harvesting.

Purpose To compare the incidence, extent of sensory loss, its clinical effect and natural course caused by sensory nerve injury, during two different skin incisions used for autogenous hamstring graft harvest during ACL reconstruction. Methods This randomized prospective study was carried out on 84 patients, divided into two groups, all of them underwent arthroscopic ACL reconstruction using hamstring tendon graft with two incisions; a vertical incision used in 43 patients, and an oblique incision in 41 patients. The location and area of sensory loss were evaluated during follow-up as well as the degree of improvement and patient satisfaction. Results The average age in this study was 29.8 ± 7.2 in the vertical group and 29.9 ± 6.3 in the oblique group. Both semitendinosus and gracilles were harvested in 34 patients, semitendinosus in 49 patients and gracilles in one patient. In the vertical group, a higher incidence of sensory loss was recorded with 21 patients (51.2%), relative to the oblique group with 18 patients (41.9%). However, there was no statistically significant difference ( p  = n.s). Most of the sensory loss affected the distribution of the IPBSN (infrapatellar branch of saphenous nerve) in 27 patients (69.2%) in both groups, and to a lesser extent in the lower medial area [distribution of SBSN (sartorial branch of saphenous nerve)] in 12 patients (30.8%). Conclusion This study clearly revealed the high incidence of nerve injury particularly the IPBSN during hamstring graft harvest, but did not prove a difference between oblique and vertical incisions, with regard to postoperative sensory loss. It was clear that harvesting the semitendinosus alone is not a factor that can diminish nerve injury. Level of evidence II.

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, a 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 cm 2 and 9.8±3.4 cm 2 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.