How to Avoid Common Complications in Hamstrings Harvest for Anterior Cruciate Ligament Reconstruction: A Practical Guide.

More than 100,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States and one of the most common autografts for ACL reconstruction (ACLR) is the HS tendons. Nevertheless, proper HS harvest can be challenging, and several complications can be encountered, including, iatrogenic neurovascular damage, premature amputation of the tendons, graft contamination, and postoperative hematoma. The aim of this technical note is to describe a safe and effective technique for autologous HS tendon harvest in ACLR.

The rule of twos: Technical note on consistent anatomical landmarks for hamstring graft harvesting.

We describe a novel hamstring harvesting technique using the "Rule of Twos" as an aide-memoire to dissect the conjoint tendon in an Asian population undergoing anterior cruciate ligament reconstruction. In a prospective study performed on 17 patients to validate this technique, a 2cm incision is placed 2cm distal and medial to the tip of the tibial tubercle. The surgeon then measured the following variables and calculated their means: 1) Distance from the tip of the tibial tuberosity to the proximal edge of the conjoint tendon (19.4 ±â€¯1.4mm), 2) Width of the conjoint tendon insertion (18.8 ±â€¯1.0mm), 3) Conjoint tendon length (20.1 ±â€¯1.0mm).

Infra Patellar Branch of Saphenous Nerve Injury during Hamstring Graft Harvest: Vertical versus Oblique Incisions.

BACKGROUND: Autologous hamstring grafts are commonly used for anterior cruciate ligament reconstruction. The injury of infrapatellar branch of saphenous nerve is one of the concerns leading to various pattern of sensory loss in the operated leg. An oblique incision to harvest the graft has been reported to be better than the vertical one.The aim of this study was to compare the incidence, recovery of nerve injury and final outcome in patients with hamstring harvest of vertical or oblique incision. METHODS: A total of 146 patients who underwent hamstring graft harvest for anterior cruciate ligament reconstruction, were included in the study. They were randomized into two (Vertical and Oblique) groups as per the incisions used. The sensory loss along the Infra Patellar Branch of Saphenous Nerve was documented on 3rd day. Recovery of the nerve injury was monitoredat three, six and 12 months follow-ups. At final follow up Tegner Lysholm score and scale was recorded to compare between two groups. RESULTS: The incidence of infrapatellar branch of saphenous nerve injury was 25% in vertical group and 16.36% in oblique group. Recovery of nerve injury started earlier in oblique group compared to vertical group. The mean TegnerLyshom score was not significantly different in both the groups. CONCLUSIONS: Oblique incision to harvest hamstring graft has lesser incidence of infrapatellar branch of saphenous nerve injury, recovers earlier and does not have any adverse effect on final outcome compared to the vertical incision.

Horizontal posterior hamstring harvest.

Harvesting of the gracilis and semi-tendinosus (ST) hamstring tendons is usually performed by anteromedial approach. Harvesting by a horizontal posterior approach is possible. Based on a series of 90 patients, this technical note describes the perioperative difficulties and the characteristics of the harvested tendon(s) as well as any complications. Only one unsuccessful harvest was reported. Posterior harvesting of the gracilis and ST hamstring tendons is a reliable, reproducible surgical technique with a low rate of complications.