Injury to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction: Comparison of horizontal versus vertical harvest site incisions

Purpose: Damage to the infrapatellar branch of the saphenous nerve (IPBSN) has been described for knee arthrotomy and arthroscopy. The true incidence of damage to this structure during anterior cruciate ligament (ACL) reconstruction has not been reported. Furthermore, the traditional vertical incision for central patellar tendon harvesting runs perpendicular to the course of this nerve. Therefore, a horizontal incision to avoid this potential complication was developed. Type of Study: Case series. Methods: A retrospective comparative study of ACL reconstructions was performed in 76 patients with central third patellar tendon as graft with a minimum of 2 years follow-up. Forty-two patients had a horizontal incision and 34 patients had a vertical incision. A questionnaire was used to evaluate function, satisfaction, and evidence of IPBSN damage. Results: There was no difference between the 2 groups with regard to scar length, pain at rest, and pain with activity. Patients with a horizontal incision were more satisfied with the cosmetic appearance of their scar (P < .004). Twenty patients (59 %) with a vertical incision had evidence of damage to the IPBSN as opposed to 18 patients (43 %) with a horizontal incision. Conclusions: Although technically slightly more difficult, a horizontal incision may be a useful option for ACL graft harvesting to provide a more satisfactory scar with less risk of IPBSN damage. Regardless of the incision used, damage to the IPBSN is a potential complication and patients should be counseled of this preoperatively. Level of Evidence: Level IV.