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Medial retinacular
4%
67/1770
Inferior genicular
30%
523/1770
Saphenous
63%
1123/1770
Superficial peroneal
2%
37/1770
Tibial
0%
7/1770
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The saphenous nerve is at risk during hamstring harvest for ACL reconstruction both at the site of the harvest incision and more proximally as a result of the tendon harvester. The saphenous nerve arises as a division of the femoral nerve and leaves the adductor canal and pierces the fascia lata between the tendons of the gracilis and sartorius. It then divides into the main saphenous branch and the infrapatellar branch (IBSN) which crosses the knee below the patella. Injury to the IBSN can result in anteromedial pain and decreased sensation over the anterolateral infra-patellar area of the leg. Figueroa et al. reported that injury rates to the IBSN during autologous hamstring harvesting for ACL reconstruction was higher than previously reported 30-59%. They found hypoesthesia of the IBSN territory was found in 17 knees (77%) with an average area of 36 cm(2) (1-120 cm(2)). Injury to the IBSN was electrophysiologically detected in 15 knees (68%). Two patients also had an injury to the saphenous nerve more proximally (9%) likely as a result of the tendon harvester. The Hoppenfeld and Medvecky references review the surgical approaches and relevant anatomy. The IBSN can be seen in Illustration A.
4.2
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