Injury to the Main Branch of the Saphenous Nerve following Hamstring Tendon Graft Harvesting: A Report of 3 Cases

Hamstring tendon grafts are commonly utilized tendon autografts; however, the harvesting procedure can result in saphenous nerve injury due to its proximity to the semitendinosus and gracilis tendons. Injury to the main branch of the saphenous nerve is a less commonly reported and understood injury during these procedures. This case report aimed to identify and present cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring tendon graft harvesting. A retrospective chart review of a tertiary-care hospital over the past 10 years was conducted. The search included clinical notes mentioning “saphenous neuropathy, neuralgia or neuritis” and magnetic resonance imaging (MRI) reports indicating saphenous nerve involvement. Patients with a history of a hamstring graft harvesting procedure and radiographically confirmed injury to the main branch of the saphenous nerve were included. Injury characteristics, symptoms, and sequential treatment were evaluated. Three cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring graft harvesting were identified. Reported symptoms included pain, paresthesia, numbness, hypersensitivity, swelling, and discoloration. All 3 patients had persistent symptoms despite non-operative treatment and therefore underwent surgical intervention, which involved resection and reconstruction using allograft or burial into adjacent musculature. Postoperatively, 2 of 3 patients demonstrated resolution of symptoms. Iatrogenic injury to the main branch of the saphenous nerve is a complication that can occur during hamstring tendon harvesting procedures, leading to severe, persistent symptoms. A better understanding of the mechanism of injury is needed to minimize the risk of iatrogenic injury.