• ACL
• ACL reconstruction
• Anterior cruciate ligament
• Tunnel blowout

• Anteromedial
• Hamstring
• Harvest
• Posteromedial
• Saphenous nerve injury

• Humans
• Hamstring Muscles
• Autografts
• Tissue and Organ Harvesting/methods
• Peripheral Nerve Injuries/surgery
• Transplantation, Autologous

The use of the posterior approach for harvesting hamstring grafts has recently become popular thanks to new all-inside techniques and retrograde drills. This study aims to compare the classic anterior approach with the posterior approach in the popliteal fossa.

Retrospective comparative study of 100 consecutive cases of primary ligamentoplasty performed using ipsilateral semitendinosus autograft with at least one year of follow-up. 50 patients with anterior approach (group A) and 50 patients with posterior approach (P). Ratio men/women: 9/1. Mean age: 32 ± 13 years. Mean operative time: 64.88 ± 12.28 min.

Graft harvest time; intraoperative complications (semitendinous [ST] tendon cut); postoperative neurological complications (allodynia, paresthesia, pain) or hematoma in the donor area; atrophy of the operated thigh compared to the contralateral thigh, postoperative VAS score, aesthetic satisfaction and overall satisfaction.

Graft harvest time of 9.5 min in group A versus 5.25 min in group P (p < 0.05). Sensory complications: 16% in group A versus 2% in group P (p < 0.05). Regarding the patient’s evaluation of the aesthetic result of the surgery, 80% in group A and 92% in group P were very satisfied, 16% in group A and 8% in group P were satisfied and 4% in group A and no patients in group P not very satisfied (p < 0.05). No significant differences were found in terms of total operative time, postoperative joint movement, atrophy of the operated thigh, postoperative VAS, or overall patient satisfaction.

The posterior approach to harvesting the ipsilateral hamstring graft obtained better results than the anterior approach in terms of aesthetic satisfaction of the patient, lower rate of neurological complications (allodynia, paresthesias and hypoesthesia in the anterior region of the knee and leg) and shorter hamstring harvest time.

IV.

• ACL reconstruction
• Popliteal fossa
• Posterior harvesting
• Saphenous nerve injury
• Semitendinosus tendon

• anterior cruciate ligament
• gracilis
• medial patellofemoral ligament
• reconstruction
• semitendinosus

• Anterior cruciate ligament
• Anterior cruciate ligament reconstruction
• Graft fixation
• Hamstring autograft
• Infrapatellar nerve injury
• Patient reported outcomes

Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel’s sign was noted on follow-up. The patient finally recovered after a 3-month follow-up. 

• Adult
• Anterior Cruciate Ligament Injuries/complications
• Anterior Cruciate Ligament Injuries/diagnosis
• Anterior Cruciate Ligament Injuries/physiopathology
• Anterior Cruciate Ligament Injuries/surgery
• Anterior Cruciate Ligament Reconstruction/methods
• Autografts
• Bone Substitutes
• Bone Transplantation/methods
• Calcium Compounds/pharmacology
• Female
• Follow-Up Studies
• Humans
• Joint Instability/diagnosis
• Joint Instability/etiology
• Joint Instability/surgery
• Knee Joint/diagnostic imaging
• Knee Joint/physiopathology
• Knee Joint/surgery
• Male
• Prospective Studies
• Radiography
• Range of Motion, Articular/physiology
• Reoperation
• Silicates/pharmacology
• Time Factors
• Treatment Outcome

• ACL
• Graft
• Hamstrings
• Morbidity
• Pes anserinus
• Sentinel blood vessel

Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference.

To describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications.

Case series; Level of evidence, 4.

This study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient’s leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed.

A total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest—no graft transections, neurovascular injuries, secondary procedures for wound healing or closure, cosmetic concerns, or limitations in return to activity due to the posterior incision.

The posterior hamstring harvest is a safe and reliable technique to harvest autograft tendon in pediatric and adolescent anterior cruciate ligament reconstructions. The posterior technique entailed no complications related to harvest. No patients expressed any cosmetic concerns about their incision or had limitations in return to sport due to the posterior harvest.

• ACL
• hamstring autograft
• hamstring tendon harvest
• pediatric ACL reconstruction

• Hamstring
• Harvesting site
• Nerve complication
• Patellar ligament
• Patellar tendon
• Prevention

• Anterior cruciate ligament reconstruction
• Hamstring muscle
• Isokinetic strength testing
• Muscle strength
• Posterior harvesting
• Quadriceps muscle

To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL).

Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted.

All the patients presented a vascular network of greater or lesser diameter.

The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting.

• Anterior cruciate ligament
• Tendons/anatomy and histology
• Tendons/transplantation

• Arthroscopy/methods
• Arthroscopy/trends
• Baseball
• Bibliometrics
• Humans
• Metaphor
• Periodicals as Topic
• Video Recording/methods