Posterior Mini-Incision Technique For Hamstring Anterior Cruciate Ligament Reconstruction Graft Harvest

by Chadwick C. Prodromos M.D., Yung S. Han B.S., Brett L. Keller, B.S, B.A., Richelle J. Bolyard, B.A.

Published in: Arthroscopy: The Journal of Arthroscopic and Related Surgery


PURPOSE: This study presents a new approach to hamstring graft harvest. The hypothesis tested was that this approach, the posterior mini-incision technique, would result in 1) consistent semitendinosus (ST) and gracilis (Gr) tendon identification 2) consistent identification and sectioning of the accessory semitendinosus tendon 3) virtual elimination of the risk of cutting hamstring grafts short 4) excellent safety, and 5) small anterior incision size with excellent cosmesis.

TYPE OF STUDY: Surgical technique

METHODS: 203 consecutive primary hamstring anterior cruciate ligament (ACL) reconstructions in skeletally mature patients were performed using this technique. 185 were located and 175 clinically evaluated. Follow-up was 24 to 113 months. Ninety patients completed a brief cosmesis questionnaire.

Seven fresh frozen knees were dissected. The locations of the ST and Gr tendons were identified in the popliteal fossa along a medial to lateral axis for purposes of incision placement. The location of the accessory ST was documented. The distance from the posterior incision to the popliteal artery was measured.

A surgical technique of the graft harvest is presented.

RESULTS: There were no complications referable to graft harvest. No tendon was cut short.

The posterior graft harvest mini-incision and the anterior tibial fixation/tibial tunnel mini-incisions were each usually about 1 inch in length. Cosmesis evaluation showed that 80% of patients felt their incisions to look better than the incisions of others they had seen who had had ACL reconstruction. None thought them worse. Cosmesis was important to a majority of patients.

CONCLUSIONS: The posterior mini-incision technique facilitated safe, rapid hamstring graft harvest and virtually eliminated the risk of cutting tendons short. Cosmesis was excellent, and was important to patients.

Key words: Anterior Cruciate Ligament Reconstruction – Semitendinosus and Gracilis – Hamstring Harvest – Surgical Technique – Cosmesis

This article was published in Arthroscopy: The Journal of Arthroscopic and Related Surgery,
Volume 21, by C.C. Prodromos, et al.
Posterior Mini-Incision Technique For Hamstring Anterior Cruciate Ligament Reconstruction Graft Harvest,
pages 130-137, Copyright 2005, and is posted with permission from the Arthroscopy Association of North America


A similar article was published as:

The Posterior Mini-Incision Approach for Hamstring Anterior Cruciate Ligament Graft Harvest

by Chadwick C Prodromos M.D.

Published in: Techniques in Orthopaedics, Sept 2005; 20(3): 200-202. Abstract


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