The One-Incision Technique for Harvesting Semitendinosus Tendon and Graft Tunneling in Arthroscopic Assisted Anterior Cruciate Ligament Reconstruction
Keywords:
Semitendinosus tendon, landmark, autogenous graft, tunneling, ACL reconstructionAbstract
Background and objective : The use of autogenous hamstring tendon especially the semitendinosus has been widely spread for anterior cruciate ligament (ACL) reconstruction. Anterior approach can be challenging due to difficult tendon identification and when the harvesting wound intended to be share for graft tunneling. This studied aim to find out the technique harvesting semitendinosus tendon and making graft tunnel through the same incision.
Method: The study was performed in 3 phases as follows.
Phase 1 : Sixty two dry cadavers were studied for their characteristics of the semitendinosus tendon, after the medical student classes.
Phase 2 : Thirty six fresh cadaveric specimen from orthopedic students and residents workshop were dissected to postulate the new technique.
Phase 3 : Thirty two cases of arthroscopic assisted ACL reconstruction using single bundle quadrupled semitendinosus tendon graft were performed in Khon Kaen Hospital.
Result : Cadaveric studied revealed that the semitendinosus tendon was located at 1 finger breadth(2 cm.) below the tibial tuberosity and ¼ inner most the width of the medial metaphysic at this level. In all fresh cadaveric dissection, we could harvest the tendon graft via a 2.5-3 cm. incisional wound. And the tibial tunneling was successfully placed through the same incision in all 32 operated cases. After surgery we found 10 cases complained numbness at the medial aspect of their shins. However, all 32 cases were appreciate in their surgical scars, and reported no pain at the harvesting wound 1 month after surgery.
Conclusion : An alternative landmark i.e.,1 finger breadth below the tibial tuberosity and ¼ the width of the medial metaphysic at this level lateral to the medial tibial crest is useful in semitendinosus tendon harvesting and graft tunneling using in the same incision in arthroscopic assisted ACL reconstruction.
