Minimally invasive semitendinosus tendon harvesting from the popliteal fossa versus conventional hamstring tendon harvesting for ACL reconstruction: A prospective, randomised controlled trial in 100 patients

• We assessed a new, minimally invasive technique of harvesting hamstring tendons.
• Our study was designed as an RCT and included 100 patients with 100% follow-up.
• The results did show statistically significant differences between the two groups.
• The incidence of damage to branches of the saphenous nerve can be reduced.
• We advocate the routine use of this technique for tendon graft harvesting.

BackgroundThis study aims to compare a technique for hamstring tendon harvesting from a postero-medial incision in the popliteal fossa with the conventional method.MethodsOne hundred patients who underwent anterior cruciate ligament (ACL)-reconstruction were randomised to either have their tendon graft harvested from postero-medial (group 1) or via an antero-medial approach (group 2). Time for tendon harvest, length of skin incision and duration of tendon harvest were recorded as well as complications and sensory disturbances in the lower leg. Pain scores were documented on the VAS scale.ResultsTime for tendon harvesting averaged one minute 23 s in group 1 versus five minutes 20 s in group 2 (p < 0.01). The skin incision measured 21 mm (group 1) versus 49 mm in group 2 (p < 0.01). The length of the harvested tendon averaged 272 mm (group 1) and 292 mm in group 2 (p < 0.01). There was one superficial wound infection in group 2 and none in group 1. Postoperative pain scores were similar in both groups. None of the patients in group 1 reported sensory disturbance in the lower leg, whilst seven patients in group 2 were found to have reduced sensation in the distribution of the saphenous nerve postoperatively (p < 0.01).ConclusionThis study confirms that harvesting the semitendinosus tendon from postero-medial is quicker, results in a shorter scar and reduces the risk of injury to branches of the saphenous nerve. However, harvesting the tendon from postero-medial resulted in a shorter tendon graft.Level of EvidenceLevel I (Randomised, controlled trial)