The semitendinosus has the longest tendon relative to its muscle belly of any hamstring muscle, its tendon beginning in the lower thigh and inserting at the pes anserinus on the medial tibial surface. This long tendon makes it the preferred hamstring for ACL reconstruction graft harvest, often used alongside the gracilis to create a four-strand hamstring graft. The regenerated semitendinosus after harvest is detectable on MRI as a reformed but smaller muscle-tendon unit by 12 months.
| Muscle | |
|---|---|
| Attachment | Long tendon beginning in the lower third of the thigh; inserts at the pes anserinus on the medial tibia, behind and below the gracilis |
Knee flexion and internal tibial rotation; pes anserinus contribution to medial knee stability
The semitendinosus, usually with the gracilis, is harvested through a small incision over the pes anserinus to make a multi-strand graft for ACL and other ligament reconstructions. Fascial bands from the tendon to the medial gastrocnemius must be divided before the tendon stripper is advanced, or the graft can be cut short. Harvest produces temporary hamstring weakness that normalises over 12 to 18 months as the muscle regenerates from the remaining proximal belly, although some studies show persistent knee flexion strength deficits at 2 years, particularly in deep flexion. Tendon regeneration appears to occur in 80 to 90 percent of patients based on MRI follow-up studies.
Proximal musculotendinous junction injury during explosive activities producing posterior thigh pain, managed conservatively with progressive loading rehabilitation.
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