Posterior Mini-Incision Technique For Harvesting the Hamstring for Anterior Cruciate Ligament Reconstruction

Developed by Chadwick C. Prodromos M.D.

The posterior mini-incision technique was developed by Dr Prodromos several years ago to address several problems with hamstring graft harvest. Traditional harvest techniques often result in grafts that are too short to use for the reconstruction. Many surgeons will not undertake a reconstruction without an allograft in the freezer in case the hamstring harvest is unsuccessful.

The mini-incision approach allows safe and reliable harvest of the hamstring. In 17 years of use of this technique, Dr Prodromos has never had a case where the harvested tendon was too short to use. Additionally he has had no cases in which complications occured.

Advantages of Using the Hamstring Tendon for ACL Reconstruction

  • The hamstring graft is the strongest available graft. [1]
  • It ligamentizes more quickly than an allograft. [2,3]
  • It has negligible donor site morbidity.[4]
  • It has unsurpassed stability results in the literature. [4]

Disadvantages of the Traditional Hamstring Harvest Technique

  • The semitendinosus and gracilis join near their insertion into a single tendon in the area where anterior ACLR incisions are made. This makes identification of the individual tendons difficult.
  • Risk of cutting the tendons short if the intertendinosus cross sections are not safely sectioned before the harvest. Poor visualization makes this dissection difficult and if not done adequately can lead to premature amputation of the semitendinosus and/or gracilis.

Advantages of Using the Posterior Mini-Incision Technique

  • The posterior incision is placed where the tendons are separate and easy to identify.
  • The technique allows the precise location of the tendinous insertions on the tibial crest. This allows the anterior incision to be very small but in the right place.
  • The anterior incision can also be used to drill the tibial tunnel and apply tibial fixation.
  • The 2 small incisions produce excellent comesis.


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