Evolution in ACL Autograft Harvesting Techniques: Transition to Minimally Invasive Autograft Harvesting

Surgical techniques for anterior cruciate ligament (ACL) reconstruction continue to evolve. Harvesting techniques for commonly used ACL autografts such as bone patellar tendon bone, hamstring, and quadriceps tendon have similarly continued to progress. Traditional larger incisions for graft harvesting that were described in the 1980s have given way to smaller or more minimally invasive techniques. Advantages of these techniques are primarily anatomy based and include the following: decreased nerve complaints such as hypoesthesia or dysesthesia, improved cosmesis, decreased surgical site pain or morbidity, and, in the case of hamstring harvesting, easier tendon identification. The current literature supports reproducible minimally invasive or modified graft harvesting techniques for bone patellar tendon bone, hamstring, and quadriceps tendon autografts. Specialized instrumentation is available to simplify the harvesting process. Each of these techniques is described in detail outlining surgical steps, technical considerations, and precautions. Knowledge and review of these techniques provides the surgeon with greater flexibility and options when choosing and harvesting autograft tissue for ACL reconstruction.