[Mini-invasive double-incision for patellar tendon harvesting in anterior cruciate ligament reconstruction].
OBJECTIVE
Injury to infrapatellar branches of the medial saphenous nerve are incriminated in disorders of the anterior aspect of the knee, particularly following bone-tendon-bone reconstruction. We demonstrated in prior anatomic work the usefulness of using a double-incision minimal approach for harvesting the patellar transplant in order to spare the nerve branches.


METHODS
The patellar transplant is harvested via two vertical incisions, one on the apex of the patella and the other along the protrusion of the anterior tibial tubercle. After harvesting the bony transplant from the patella, discision of the patellar tendon fibers is advanced subcutaneously towards the anterior tibial tubercle, allowing extraction of the patellar graft via the tibial incision using a small forceps and respecting the peritendon. The tibial bone is then harvested. The standard anterolateral and anteromedial approaches are used for the ligament reconstruction.


RESULTS
We have conducted a case control study between this harvesting technique using the double-incision technique (42 knees) versus the conventional single incision harvesting technique. We studied the influence of the harvesting technique on anterior knee pain, the surface area of the sensorial disorders involving the anterior aspect of the knee, and kneeling problems.


CONCLUSIONS
Our technique has enabled a significant decrease in the surface area of sensorial disorders (7.4 cm2 versus 17.4 cm2) and problems kneeling compared with the conventional method.
Drain
O
O
Service de Chirurgie Orthopédique, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay Cedex.
Beaufils
P
P
Thevenin Lemoine
C
C
Boggione
C
C
Katabi
M
M
Charrois
O
O
Boisrenoult
P
P
D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D018771:Arthralgia / Q000517:prevention & control; D016025:Bone Transplantation / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain / Q000517:prevention & control; D010329:Patella / Q000601:surgery; D017847:Patellar Ligament / Q000601:surgery / Q000637:transplantation*; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012678:Sensation Disorders / Q000517:prevention & control; D013977:Tibia / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*