Nerve injury after knee arthroscopy, ACL reconstruction, multiligament knee, and open knee surgery

The overall complication rates after knee arthroscopy, ligament reconstruction, and other sports medicine procedures are relatively low. However, iatrogenic injury to the nervous structures about the knee is possible if care is not taken with surgical approaches and technique. Injuries to the saphenous nerve and peroneal nerve in particular have been described in association with routine arthroscopic procedures, meniscal repair, ligamentous reconstructions, high tibial osteotomies, and total knee arthroplasty. Understanding the injury mechanisms, diagnosis, and management of these injuries begins with a detailed familiarity with the neural anatomy about the knee. Prompt identification of nerve injury is important and requires a discerning sports medicine practitioner to maintain a high index of suspicion in the appropriate situations. Awareness of structures at risk when performing surgical procedures about the knee reduces incidence of iatrogenic injury. This chapter offers in-depth descriptions of the neural anatomy about the distal thigh, knee, and proximal leg, empowering the reader to safely perform both arthroscopic and open procedures in this region. For cases where nerve insult is encountered, descriptions of the workup and management of these injuries are provided in detail.