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

ABSTRACT

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).