Aim: To describe a new cosmetic and simple approach to harvest hamstring tendons in arthroscopic ACL reconstruction which reduces anterior knee sensitivity and patient morbidity.

Methods: Pre-operatively, the path of the hamstring tendons is identified and marked by asking the patient to flex their knee against resistance.

The thigh is placed over a bolster and the leg is allowed to hang over the end of the table.

The hamstring tendons are harvested through the pre-determined 2 centimetres horizontal incision on the posterior medial aspect of the thigh. The hamstring tendons which are individually identifiable at this point are isolated using a tendon hook. The fascial expansions of the tendons, which are easily accessible by this approach, are divided using dissecting scissors. A tendon stripper is then used to free the tendon from its muscular origin proximally and from its insertion at the pes anserinus distally.

Only a 5mm stab incision anteromedially is now required to make the tibial tunnel. The rest of the procedure is performed as described by EM Wolfe (1). The posteromedial incision is closed with subcuticular stitches. All other wounds are closed with steristrips including the 5mm anteromedial stab incision.

Conclusion: This new approach has a short learning curve with the harvesting time falling from 22 minutes to 9 minutes within the first 4 procedures, making it a good technique for the trainee surgeon. This approach provides an alternative to the traditional approach by being cosmetically pleasant, reducing anterior knee sensitivity and thereby improving the outcome.