The following is a cadaveric demonstration of my preferred technique for hamstring harvest, which is through a small popliteal incision. It's very minimally invasive and cosmetic for patients, easy to do, and I think has an advantage particularly for harvesting the semitendinosus, because you can see very easily the accessory band that's present in over 70% of the cases, and that's the band that could cause you to prematurely cut the tendon off when you come from the tibial side with your stripper. It's very easy to see here looking at it on the popliteal approach. So I first marked on the skin the patella, medial joint line, and the orientation of the hamstrings to help you understand where this incision is. It's very much located posteriorly, as I'm showing with my probe, it's in the popliteal crease midline. It's a short two-centimeter incision right in the crease, and that's how it's cosmetic. The hamstrings are very superficial, so you go through the skin, and there's a first fascial area you incise, and immediately thereafter will be the hamstrings. The semitendinosus is centrally located, has a bit of fat about it typically as you see here. I isolate it with a hemostat. I'll pass a passing suture around it. The semitendinosus is more central. It's larger, more mobile in the popliteal area here than the gracilis, which is more medially located and superficial and smaller. So I pass my suture around the semitendinosus to help maintain traction. Then you need to release soft tissue overlying it. The messenbaum scissors work excellently here. Traction with my suture. You can see this little fascial-type tissue, I release that so I can pass my tendon stripper approximately, which will be an open-ended stripper. Free up the tendon like this, and then distally, I'll show you very nicely in this cadaver, the accessory band. Here it is like a web. That's what can trap you and make you cut the tendon off prematurely coming from below. So I'm looking right at it. I release the accessory band. Now I have a straight shot at my tendon directly to the tibia. So first I'm going to use the open-ended pigtail stripper. I pass it in the line of the hamstring, maintaining traction on the suture in my finger, and I get an excellent length, as you see here, released at the muscle-tendon junction. Strip that muscle off, and you have plenty of good tendon there to work with when you want to make your quadruple semi-T construct for your ACL reconstruction. To release it off the tibia, I use a small, shorter closed-ended stripper. Again, now it's a straight shot since I've released the accessory band. You can see the tibia where I push on the skin. That's the attachment point for the semitendinosus. This is like a very sharp elevator. I just put a little pressure on my back hand and forward with my right hand, and I release the tendon, as you see here. Excellent length, usually 280 millimeters. Plenty of tendon for the quadruple construct, and very easily done, minimally invasive, closing that incision.

minimally invasive technique

hamstring tendon harvesting

popliteal incision

semitendinosus tendon

ACL reconstruction

minimally invasive

hamstring harvesting