The semitendinosus inserts as the posterior component of the pes anserinus on the medial proximal tibia. Together with the gracilis it forms the most commonly harvested graft complex for ACL reconstruction — the two tendons together provide a four-strand hamstring graft of approximately 8 mm diameter with adequate length. Its harvest leaves a functional deficit only in high-speed sprinting (less than 5% strength difference at 12 months).
Knee flexion and internal tibial rotation through the pes anserinus; medial knee dynamic stabiliser
The semitendinosus and gracilis tendons are identified and harvested through a 3-4 cm incision over the pes anserinus. A tendon stripper is passed along the tendon to disengage the muscle belly. The fascial expansions from the semitendinosus to the gastrocnemius fascia must be released to prevent tendon amputation during stripping.
Semitendinosus and gracilis tendon harvest for ACL reconstruction — careful release of fascial expansions prevents graft amputation during tendon stripping.
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