Abstract
Purpose of Study: To study the anatomy of the accessory bands of Gracilis and Semitendinosus in order to avoid inadequate graft harvesting during ACL reconstruction.
Methods and Results: Data was collected from 25 arthroscopically performed ACL reconstructions using the hamstring tendons. For each patient the exact number of accessory insertion bands of the Gracilis and Semitendinosus was recorded, as well as the distance of the proximal most band from the main insertion point on the tibial crest.
Of the 25 Gracilis tendons, the most common number of accessory bands was 2, varying from 0 to 3. The average distance of the proximal most band was 5.14cm. The most common number of accessory bands for the Semitendinosus tendon was 3, varying from 1 to 4. The average distance of the proximal most band was 8.14cm. Five of the Semitendinosus and none of the Gracilis tendons had a proximal band located > 10cm. Average length and diameter of the four strand graft was 7.7cm and 13.2cm.
Conclusion: Gracilis and Semitendinosus tendons are increasingly being used for soft tissue reconstructions. Awareness of accessory bands of these tendons is essential in preventing diversion of the tendon stripper leading to a short and inadequate graft. Previous studies have shown that the anatomy of these bands is highly varied. Such cadaveric studies have shown a high percentage of tendons with bands > 10cm proximal to their insertion [2]. Our study shows that 20% of Semitendinosus and none of the Gracilis tendons had bands more than 10cm proximal to their insertion. Gaining knowledge about accessory insertion bands of the hamstrings should assist reproducible and adequate graft harvest.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
