Minimally invasive posterior hamstring harvest

Abstract

Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks.

Fig 1

A 2-cm longitudinal incision is marked over the prominent posteromedial hamstring tendons, just proximal to the popliteal crease (left leg, viewed from medial perspective).

Fig 2

A Penrose drain is passed around the tendon for better control (left leg, viewed from medial perspective).

Fig 3

An open minimally invasive graft harvester is used to strip the tendon proximally.

Fig 4

A closed minimally invasive graft harvester is used for harvesting the tendon off of the tibial cortex at the pes anserinus. It is used as a periosteal elevator to strip the tendon from its insertion.

Fig 5

While firmly grasping the free tendon end with a dry sponge, the surgeon advances the closed graft harvester carefully, yet progressively, toward the tendon's insertion on the tibial cortex at the pes anserinus (left leg, viewed from medial perspective). The closed harvester is used as a periosteal elevator to elevate the tendon from its site of attachment.