Posteromedial Hamstring Tendon Harvest for All-Inside Anterior Cruciate Ligament Reconstruction: Graft Characteristics, Technical Considerations, and Donor-Site Outcomes

Background: Hamstring autografts are commonly harvested through an anteromedial (AM) incision over the pes anserinus, an approach associated with visible anterior scarring, premature tendon transection, and injury to branches of the saphenous nerve.Posteromedial (PM) harvest through the popliteal crease provides an alternative route to the semitendinosus and gracilis tendons and may be particularly suited to ligament reconstruction procedures that require little or no AM tibial exposure.Case presentation: Six consecutive patients undergoing primary all-inside anterior cruciate ligament (ACL) reconstruction underwent PM hamstring tendon harvest through a transverse popliteal crease incision.Both the semitendinosus and gracilis tendons were harvested and prepared as quadrupled graft constructs.Harvest time, incision length, tendon length, graft diameter, donor-site morbidity, and postoperative clinical outcomes were evaluated.Results: PM harvest was successfully completed in all six patients without conversion to an AM approach or premature tendon transection.Mean harvest time was 14.0 minutes (range: 8-25 minutes), and mean incision length was 3.08 cm (range: 2.0-5.5 cm).Semitendinosus and gracilis tendon lengths ranged from 24 to 28 cm and 22 to 28 cm, respectively.Mean final graft diameter was 8.9 mm (range: 8.5-9.5 mm), with all grafts measuring at least 8.5 mm.Five patients reported no donor-site or neurological symptoms.One patient developed transient PM harvest-site pain and persistent medial leg paraesthesia.No wound complications, infection, or haematoma occurred.Conclusion: PM hamstring harvest provided graft dimensions sufficient for all-inside ACL reconstruction in all six patients while avoiding a conventional harvest incision over the pes anserinus.The approach may be useful when minimal or no AM tibial exposure is otherwise required, including all-inside ACL and isolated medial patellofemoral ligament reconstruction.Saphenous nerve-related sensory disturbance remains possible, and careful tendon identification and controlled stripper advancement are required.Larger comparative studies are needed to establish the relative benefits and risks of this approach.