Avoiding Anomalous Tendon Harvest at the Pes Anserinus Insertion

Area of Science:

• Orthopedic Surgery
• Pediatric Sports Medicine
• Anatomical Variations

Background:

• Pes anserinus tendon morphology is crucial for anterior cruciate ligament (ACL) reconstruction graft harvesting.
• Anatomical variations in the pes anserinus can complicate tendon harvesting procedures.
• Adolescent athletes undergoing ACL surgery may present unique anatomical considerations.

Purpose of the Study:

• To determine the frequency and characteristics of anomalous pes anserinus tendon morphology in adolescents.
• To evaluate the implications of these anomalies during ACL reconstruction surgery.
• To assess the utility of preoperative imaging in identifying these variations.

Main Methods:

• Retrospective review of 123 adolescent patients (mean age 16.1 years) undergoing ACL reconstruction.
• Analysis of operative reports for indications of pes anserinus anomalies or harvesting difficulties.
• Review of magnetic resonance imaging (MRI) studies for evidence of anomalous pes anserinus structures.

Main Results:

• Anomalous pes anserinus tendon morphology was identified in 2.4% of the study population (3 out of 123 patients).
• The anomaly involved a low-lying muscle belly and accessory tendon during gracilis harvest, with the muscle belly ~5 cm from insertion.
• MRI analysis suggested possibilities including aberrant semimembranosus, anomalous gracilis, or thickened sartorius tendon.

Conclusions:

• Anomalous pes anserinus tendons occur in 2.4% of adolescents undergoing ACL reconstruction.
• A low-lying muscle belly (<6 cm tendon length) during harvest may indicate an aberrant tendon.
• Preoperative MRI can potentially identify these anomalies if specifically investigated.