Hamstring Harvest and Principles of Autograft Reconstruction

Sydney C. Karnovsky

Mark C. Drakos

Positioning (Supine or Prone)

Place the patient in a supine or prone position, depending on what position is needed for the rest of the case.
Place a nonsterile tourniquet on the operative thigh. Prep and drape the lower extremity in a sterile manner.
Exsanguinate the lower extremity and inflate the tourniquet 250 mm Hg.

Surgical Approach

Perform a medial approach to the tibia. Make a 3-cm incision at the midway point between the top of the tibial tubercle and the posteromedial border of the tibia using a #15 blade knife (Figures 11-1 and 11-2).
Use a knife and a 90° right-angle clamp to expose the site of interest and divide the sartorial fascia in line with its fibers, exposing both the gracilis and semitendinosus. This is oblique to your prior incision (Figure 11-3).
Identify the gracilis and semitendinosus between the sartorial fascia and the superficial medial collateral ligament. They are in between layer 1 and layer 2 (Figure 11-4).
Identify the gracilis and/or semitendinosus and then place a Penrose around each tendon (Figures 11-5, 11-6, 11-7).

The tendon will be held in place with multiple adhesions to the medial head of the gastrocnemius.

Remove those adhesions using the Metzenbaum scissors.

Figure 11-1. The incision will be at the dashed line, between the tibial tubercle (the box) and the posteromedial border of the tibia (the dot). The patient is in a prone position.

Figure 11-2. The incision will be at the dashed line, between the tibial tubercle (the circle) and the posteromedial border of the tibia. The patient is in a supine position.