The distal gracilis tendon inserts onto the medial tibia at the pes anserinus, posterior to and below the sartorius and anterior to the semitendinosus insertion. The tendon is slender and approximately 15-20 cm long, making it suitable for harvest as an autograft for knee ligament reconstruction. It is harvested through a small medial tibial incision using a tendon stripper advanced along the tendon into the thigh.
The gracilis tendon is harvested alone or in combination with the semitendinosus tendon for ACL reconstruction using hamstring graft technique. The combined gracilis-semitendinosus graft (double-bundle or quadrupled) provides 7-9 mm diameter graft suitable for ACL reconstruction. The gracilis tendon is the smaller of the two and is sometimes spared if only a single tendon graft is needed. Donor site morbidity from gracilis harvest is minimal; there is a 5-10% reduction in inner thigh strength. The gracilis muscle-tendon unit is also used as a free muscle transfer for facial reanimation.
Gracilis tendon harvest through a 3-4 cm medial tibial incision using a closed-ended tendon stripper provides 20-24 cm of slender tendon graft; the stripper must be advanced parallel to the tendon, not perpendicular, to avoid premature amputation; combined with semitendinosus it provides a quadrupled hamstring graft for ACL reconstruction.
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