A new technique of graft harvest for anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft

Abstract

A new technique of graft harvesting was used in 8 cases for arthroscopic anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft. The graft is acquired through a small incision on the posteromedial aspect of the knee at the flexor crease instead of the standard anteromedial approach through a paramedian incision. Compared with the standard technique of graft harvesting, this new method of graft harvest facilitates easier identification of the semitendinosus and avoids inadvertent amputation of the semitendinosus tendon during graft harvest, disinsertion of the pes anserinus, or injury to the infrapatellar branch of saphenous nerve. The surgical scars, in addition to the standard portal scars, include a small scar on the posteromedial aspect, which merges into the flexor crease and a 1-cm anteromedial scar. This provides improved cosmesis and better patient compliance for early rehabilitation with less pain in the immediate postoperative period. There is no compromise on the intraoperative ligament reconstruction with good postoperative results. No intraoperative or postoperative complications were encountered. It would be advisable to follow this technique of graft harvesting for all individuals undergoing arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon to avoid the problems encountered with the standard technique, and also to achieve an excellent cosmetic and functional outcome.

Posterior semitendinosus tendon harvesting minimizes the risk of injury to the infrapatellar and sartorial branches of the saphenous nerve

“…Franz and Prodromos described the technique of posteromedial ST tendon harvest with the purpose of minimizing iatrogenic injury to the IBSN and SBSN 15,23 . Low complication rates have also been reported by several authors who have used the posteromedial approach 15,16,19,24,25 . Our study is in accordance with these reports.…”

“…To our knowledge, there are no reports in the literature about iatrogenic damage to the IBSN or SBSN during isolated posterior ST harvesting. Moreover, posterior harvesting allows for shorter operating times, easier ST tendon identification, better cosmetic results and greater patient satisfaction 15,18,24 . When retrograde tibial drilling is used, the scar over the anterior tibia is minimal and the harvesting wound scar is hidden in the popliteal fossa.…”

Anatomic Considerations in Hamstring Tendon Harvesting for Ligament Reconstruction

“…Arthroscopically assisted ACL reconstruction using medial hamstring tendons is not free of complications such as disinsertion of the pes anserinus, amputation of the graft, and injury to the IPBSN. 13 Vertical, horizontal, and even oblique incision methods have been proposed for medial hamstring tendon harvesting, at an approximate distance of 2.5 to 4 cm from the tibial tuberosity.…”

Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest

“…12,28 Kodkani et al reported that two incisions, one is at 1 cm distal of tuberositas tibia, another at flexion line of the knee, are safer in hamstring tendon harvest. 31 All authors accept the knee to be kept in flexion and thigh is recommended to be kept in external rotation during graft harvest. So, saphenous nerve goes to posterior and draws away from the surgical site.…”