The gracilis tendon is the middle component of the pes anserinus on the medial tibia, identifiable between the sartorius (anterior) and semitendinosus (posterior) during resisted knee flexion. Long, slender and uniform, it is commonly harvested with the semitendinosus to form a four-strand hamstring graft for ACL reconstruction. Because its loss is well compensated by the other adductors, the gracilis muscle is also used as a free muscle transfer for facial reanimation and in reconstructive surgery.
| Muscle | |
|---|---|
| Attachment | Medial surface of the tibia at the pes anserinus, the middle of the three pes tendons, between sartorius anteriorly and semitendinosus posteriorly |
Knee flexion, medial tibial rotation and hip adduction force transmission; pes anserinus medial knee stability
Gracilis harvest is performed through a small incision over the pes anserinus medial to the tibial tuberosity, after opening the overlying sartorial fascia, and a tendon stripper is advanced parallel to the tendon. Combined with the semitendinosus it gives a quadrupled graft of roughly 7-9 mm diameter. Loss of the gracilis causes little lasting weakness, which is why the muscle is the preferred free muscle transfer for facial reanimation. Its pes anserinus contribution to medial knee stability means harvest can marginally increase medial knee laxity in some patients, but this is clinically insignificant in most cases.
Medial tibial pain at the pes anserinus harvest site after gracilis or semitendinosus graft for ACL reconstruction, usually resolving within 3 to 6 months.
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