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Minimally Invasive Anterior Semitendinosus Harvest: A Technique to Decrease Saphenous Nerve Injury.

ABSTRACT: Hamstring tendon harvest, especially semitendinosus harvest, has been widely used in anterior cruciate ligament reconstruction for many years. However, donor site morbidity has been described regarding the infrapatellar branch of the saphenous nerve. Minimally invasive anterior semitendinosus harvest is a simple, safe, reproducible, and elegant technique. A 2-cm vertical incision above the pes anserinus is performed 2 cm medial to the tibial anterior tubercle. The fascia superficialis is opened with a horizontal incision, and the gracilis is isolated using a retractor. The semitendinosus is grabbed with a probe, and the vincula are hooked one by one. The tendon is harvested with a closed stripper. The expansions are cut, and the tendon is detached from the bone with part of the periosteum.

SUBMITTER: Colombet P

PROVIDER: S-EPMC4885910 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Minimally Invasive Anterior Semitendinosus Harvest: A Technique to Decrease Saphenous Nerve Injury.

Colombet Philippe P Graveleau Nicolas N

Arthroscopy techniques 20160208 1

Hamstring tendon harvest, especially semitendinosus harvest, has been widely used in anterior cruciate ligament reconstruction for many years. However, donor site morbidity has been described regarding the infrapatellar branch of the saphenous nerve. Minimally invasive anterior semitendinosus harvest is a simple, safe, reproducible, and elegant technique. A 2-cm vertical incision above the pes anserinus is performed 2 cm medial to the tibial anterior tubercle. The fascia superficialis is opened ...[more]

PMID: 27274445

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Project description:Recent systematic reviews have shown anterior cruciate ligament reconstruction using quadriceps tendon (QT) grafts to have superior clinical outcomes compared with traditional bone–patella tendon–bone and hamstring tendons grafts. Using minimally invasive techniques to harvest the QT graft can reduce postoperative pain and intraoperative surgical time. This technique is usually performed with a distal-to-proximal approach but often has issues of inadvertently harvesting a graft short of the desired length or causing a hematoma. As an alternative, we introduce a minimally invasive approach with a proximal-to-distal harvest technique that results in better visualization of tissue planes, more consistent graft sizes, lower risk of inadvertent arthrotomy, and reduced risk of hematoma. The minimally invasive QT graft harvest with a proximal-to-distal approach can offer unique advantages over the current standard distal-to-proximal approach. Technique Video Video 1 In this video, we demonstrate a novel technique for harvesting the quadriceps tendon (QT) for anterior cruciate ligament reconstruction. The patient is supine on the operating table with the leg flexed over the side of the bed for dissection and harvest. The harvest can be adequately done with a 2-cm horizontal incision approximately 8 to 9 cm proximal to the patella. Before the incision the vastus medialis obliquus, rectus femoris (RF), and patella are outlined. The Arthrex QuadPro can be used as a ruler as seen here. Through a 2-cm horizontal incision, subcutaneous fat is dissected to reveal the facial envelope of the RF and QT. A split is made in the fascia, which usually reveals a small amount of fat overlying the tendon. Pretendinous fat and adhesions are removed to expose the RF tendon. The next step is to feather off the musculotendinous junction. At this proximal level, the muscle of the quadriceps begins to envelope the tendon making the tendon width appear smaller than it actually is. This can be done with a scalpel, key elevator, knife, Cobb, or any other sharp instrument. Adequate feathering of the muscle bellies will show a wide tendon adequate for harvest. A rectangular-shaped tenotomy consistent with the harvester diameter or slightly larger is performed in the RF tendon. Below, the VI will come into view. This is a proximal to distal view of the plane between the RF and VI. The RF is then quickly whip stitched. Blunt dissection is performed above and below the RF tendon to allow easier passage of the harvester. The graft is loaded into the harvester. We know from anatomical studies that the tendon 2-cm distal to our tenotomy should begin to splay out and widen. Furthermore, the central aspect of the RF tendon is not in the center of the patella but about 10% lateral due to the Q angle of the tendon. Therefore, direct visualization of the harvest path 2-cm distal and aiming at the proximal pole of the patella just off center laterally should minimize the risk of poor trajectory leading to short graft harvest. The desired length is seen on the harvester and the graft is amputated. A 9-mm harvester was used in this example, which yields a graft that will easily pass through the corresponding tunnel or will be a snug fit slightly smaller as seen. There are various graft fixation methods. A reliable and reproducible fixation method is the Arthrex FiberTag.

Dataset Information

Minimally Invasive Anterior Semitendinosus Harvest: A Technique to Decrease Saphenous Nerve Injury.

Publications

Minimally Invasive Anterior Semitendinosus Harvest: A Technique to Decrease Saphenous Nerve Injury.

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