Posterior Hamstring Harvest and Preparation for Quadruple Autograft All-Inside Anterior Cruciate Ligament...

Hamstring tendon autografts are the most commonly used grafts for anterior cruciate ligament (ACL) reconstruction and are usually harvested through an anterior approach. This harvest is not without risks of complications, and the tendons can alternatively be harvested through a posterior approach.

Patients undergoing autograft hamstring ACL reconstruction without previous ipsilateral hamstring harvest or distal hamstring injury.

The patient is positioned supine, and the leg is elevated. With the knee in flexion, the semitendinosus can be palpated as the most lateral superficial of the medial hamstring tendons. A small incision is then made over the semitendinosus 1 cm proximal to the flexion crease, and the fascia is opened. An open hamstring stripper is then used to harvest the graft proximally with the leg in extension. The graft is then passed through a closed tendon stripper, and the remaining tendon is stripped distally. The graft is then quadrupled on the back table with the sutures on the inside of the graft, and the graft is soaked in a tobramycin-infused saline solution.

Compared to anterior hamstring harvest, posterior harvest is associated with a decreased incidence of (infrapatellar branch) saphenous nerve damage (0.4% vs 10.2%), lower risk of premature graft harvest (0% vs 2-9%), shorter operative time (4 to 13 minutes shorter), and higher cosmetic satisfaction (92% vs 80%).

Posterior hamstring harvest is a safe and reliable technique that is associated with a lower risk of complications compared to anterior hamstring harvest and should be considered for hamstring autograft ACL reconstruction.

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