Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest

Although the semitendinosus and gracilis tendons have long been used in ligamentous reconstruction proce dures of the knee, their anatomic relationships have not been explicitly detailed. Therefore, cadaveric dissec tions were performed on fresh-frozen adult knees to examine these relationships. Several key anatomic points are useful in the harvest of these tendons. Their conjoined insertion site is medial and distal to the tibial tubercle. They become distinct structures at a point that is farther medial and slightly proximal. Tendon harvest is facilitated by identifying the tendons proximal to this point. The superficial medial collateral ligament lies deep to the tendons in this area and should not be disturbed. The tendons are ensheathed in a dense fascial layer that may impede tendon stripping. The accessory insertion of the semitendinosus tendon (which was present in 77% of the knees dissected) should be identified and transected to avoid tendon damage at harvest. Knee flexion may reduce the risk of injury to the saphenous nerve as it crosses the gracilis tendon. Variation in tendon diameter affects graft strength.