Posterior mini-incision technique for hamstring anterior cruciate ligament reconstruction graft harvest

Purpose: This study presents a new approach to hamstring graft harvest. The hypothesis tested was that this approach, the posterior mini-incision technique, would result in (1) consistent semitendinosus (ST) and gracilis (Gr) tendon identification, (2) consistent identification and sectioning of the accessory semitendinosus tendon, (3) virtual elimination of the risk of cutting hamstring grafts short, (4) excellent safety, and (5) a small anterior incision with excellent cosmesis. Type of study: Surgical technique. Methods: Two-hundred three consecutive primary hamstring anterior cruciate ligament reconstructions were performed in skeletally mature patients using this technique. Of these, 185 were located and 175 were clinically evaluated. Follow-up was 24 to 113 months. Ninety patients completed a brief cosmesis questionnaire. Seven fresh-frozen knees were dissected. The locations of the ST and Gr tendons were identified in the popliteal fossa along a medial-to-lateral axis for purposes of incision placement. The location of the accessory ST was documented and the distance from the posterior incision to the popliteal artery was measured. Results: There were no complications referable to graft harvest. No tendon was cut short. The posterior graft harvest mini-incision and the anterior tibial fixation/tibial tunnel mini-incisions were each usually about 1 inch in length. Cosmesis evaluation showed that 80% of patients thought their incisions looked better than the incisions of others they had seen who had had anterior cruciate ligament reconstruction. None thought them worse. Cosmesis was important to a majority of patients. Conclusions: The posterior mini-incision technique facilitated safe, rapid hamstring graft harvest and virtually eliminated the risk of cutting tendons short. Cosmesis was excellent, and was important to patients. Level of evidence: Level V.