ANATOMIC CONSIDERATIONS IN HARVESTING THE SEMITENDINOSUS AND GRACILISTENDONS AND A TECHNIQUE OF HARVEST

Although the semitendinosus and gracilis tendons have long been used i n ligamentous reconstruction procedures of the knee, their anatomic re lationships have not been explicitly detailed. Therefore, cadaveric di ssections were performed on fresh-frozen adult knees to examine these relationships. Several key anatomic points are useful in the harvest o f these tendons. Their conjoined insertion site is medial and distal t o the tibial tubercle. They become distinct structures at a point that is farther medial and slightly proximal. Tendon harvest is facilitate d by identifying the tendons proximal to this point. The superficial m edial collateral ligament lies deep to the tendons in this area and sh ould not be disturbed. The tendons are ensheathed in a dense fascial l ayer that may impede tendon stripping. The accessory insertion of the semitendinosus tendon (which was present in 77% of the knees dissected ) should be identified and transected to avoid tendon damage at harves t. Knee flexion may reduce the risk of injury to the saphenous nerve a s it crosses the gracilis tendon. Variation in tendon diameter affects graft strength.