21/07/2025
Giảm tổn thương thần kinh hiển (gây cảm giác tê mặt trong gối) sau mổ tái tạo dây chằng, bằng cách lấy mảnh ghép gân tứ đầu đùi
📃📝“Saphenous nerve injury after anterior cruciate ligament reconstruction”
Injury to the infra-patellar branches of the saphenous nerve (IPBSN) is the main neurological complication of ACL reconstruction.
Quadriceps tendon (QT) autograft may protect IPBSN due to less invasive tibial approach.
Aim: Compare the numbness surface area after ACL reconstruction using hamstring tendon (HT) vs. quadriceps tendon (QT) autografts.
🧬 Anatomical Insight
IPBSN gives sensory supply to anterior/proximal leg.
High anatomical variability makes a safe incision zone impossible.
QT harvest does not intersect nerve paths, reducing risk.
🩺 Clinical Implications
QT autograft reduces neurological complications: Quadriceps tendon harvest results in a significantly smaller numbness area and fewer infra-patellar branch of the saphenous nerve (IPBSN) injuries than hamstring tendon harvest.
Better sensory outcomes: The rate of real IPBSN lesions was four times lower in the QT group (17.8% vs. 76%), making it a safer choice regarding postoperative hypoesthesia.
Shorter incision = less risk: The QT approach requires a shorter and more localized incision, which minimizes subcutaneous dissection and avoids crossing critical nerve paths.
Low donor site morbidity with QT: No complications such as quadriceps tendon rupture, patellar fracture, or extensor mechanism weakness were reported in the QT group.
Sensory changes are well tolerated: Despite high rates of IPBSN injury in HT procedures, functional outcomes are rarely affected, though awareness and patient education are important.
📌 Key Takeaways
🧠 QT autograft offers a neuroprotective advantage in ACL reconstruction due to limited disruption of the saphenous nerve pathway.
📉 Numbness surface area and scar length are significantly reduced in QT compared to HT.
📈 Strong correlation exists between scar length and numbness area.
📌 Hypoesthesia was the most common sensory disturbance (87.5% of cases); other forms (hyperesthesia, anesthesia) were rare.
🧪 No difference in functional outcome, even in patients with sensory deficits—but techniques that reduce nerve damage should still be prioritized.
🔬 Further research is needed on ultrasound-guided incisions and systematic oblique tibial skin incisions to further minimize IPBSN injury.
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