Purpose
The infrapatellar branch of the saphenous nerve (IPBSN) is a cutaneous nerve of the lower extremity that emerges distally to the adductor or the subsartorial canal.
Its anatomical features are well-known to be varied both between individuals,
as well as within the both limbs of the same person,
and include e.g.
emergence in respect to the sartorius muscle (SaM),
its course,
branching and morphometrics.
Iatrogenic injuries to the said nerve may occur during surgical procedures on the anteromedial side of the knee,
resulting in sensory...
Methods and Materials
The authors assessed the topic in cadaveric (n=100),
ultrasonographic (n=30) and meta-analytical evaluations.
The incidence of iatrogenic IPBSN injury was simulated on each cadaveric limb by using vertical,
horizontal or oblique incisions.
The reviewers further described the emergence points of the IPBSN in respect to the SaM and classified it as: type A – anterior; type B – posterior; or type C – penetrating the muscle.
The meta-analytical part of the study involved the search of all the major electronic medical databases for articles reporting...
Results
The meta-analysis of the IPBSN’s emergence involved six studies (n=336 limbs,
including the present study).
The type C was the most common point of origin of the nerve (42.9%),
followed by the type B (41.9%).
The meta-analysis of incidence of iatrogenic IPBSN injury involved ten studies (n=936 patients).
The highest incidence of iatrogenic injury (57.2%) was attributed to the vertical incisions,
followed by the horizontal (28.9%) and the oblique (25.6%) techniques.
The horizontal distance between the IPBSN and the medial border of the patellar ligament...
Conclusion
It can be noticed from our study that the anatomy of the IPBSN is varied to a great extent.
Awareness of those variations might help alleviate the risks of sensory impairments following e.g.
the total knee arthroplasty,
arthroscopy,
arthrotomy with meniscectomy,
prepatellar bursae resections,
or even the antegrade tibial nailing.
The highest risk of nerve injury was associated with the type B emergence,
due to its proximity to the harvested tendons.
Henceforth,
during the hamstring tendon grafting we suggest the use of the oblique incision...