Traumatic Neuroma of the Infrapatellar Branch of the Saphenous Nerve after Hamstring Harvesting

ABSTRACT

We describe a case of a 47-year-old man with radiating pain and a palpable subcutaneous nodule on the medial side of the upper leg 10 years after hamstring anterior cruciate ligament reconstruction. Clinical and radiological investigations were highly suggestive for a neuroma of the infrapatellar branch of the saphenous nerve. After surgical excision, the diagnosis of traumatic neuroma was confirmed by pathology evaluation. To our knowledge, no similar case has previously been reported.

KEYWORDS

ACL reconstruction - hamstring harvesting - nerve damage - complication

REFERENCES

• 1 Chambers G H. The prepatellar nerve. A cause of suboptimal results in knee arthrotomy.  Clin Orthop Relat Res. 1972;  82 157-159
• 2 Sanders B, Rolf R, McClelland W, Xerogeanes J. Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury.  Arthroscopy. 2007;  23 956-963
• 3 Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts.  Arthroscopy. 2001;  17 971-980
• 4 Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C. Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study.  Knee. 2008;  15 360-363
• 5 Arthornthurasook A, Gaew-Im K. Study of the infrapatellar nerve.  Am J Sports Med. 1988;  16 57-59
• 6 Horner G, Dellon A L. Innervation of the human knee joint and implications for surgery.  Clin Orthop Relat Res. 1994;  301 221-226
• 7 Kartus J, Ejerhed L, Eriksson B I, Karlsson J. The localization of the infrapatellar nerves in the anterior knee region with special emphasis on central third patellar tendon harvest: a dissection study on cadaver and amputated specimens.  Arthroscopy. 1999;  15 577-586
• 8 Tifford C D, Spero L, Luke T, Plancher K D. The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study.  Am J Sports Med. 2000;  28 562-567
• 9 Mochizuki T, Akita K, Muneta T, Sato T. Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons.  Surg Radiol Anat. 2003;  25 192-199
• 10 Portland G H, Martin D, Keene G, Menz T. Injury to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction: comparison of horizontal versus vertical harvest site incisions.  Arthroscopy. 2005;  21 281-285