title: Localization of the semitendinosus-gracilis tendon bifurcation point relative to the tibial tuberosity: an aid to hamstring tendon harvest.
abstract: OBJECTIVE
  Autologous hamstring grafts are commonly used for knee reconstruction. The proximity of the saphenous nerve and its branches, the superficial medial collateral ligament, and the inherent variability of fascial attachments necessitates effective surgical incision placement to minimize tissue morbidity during graft harvest. This study describes a method of locating the semitendinosus and gracilis tendon bifurcation point relative to the tibial tuberosity. It uses a novel diagonal surgical incision placed between a proximal point placed 3 cm medial to the tibial tuberosity and at 3 cm distal and 5 cm medial to the tibial tuberosity.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Thirty-one cadaveric knees (17 right, 14 left) were placed in a jig at 90 degrees flexion. Reference marks were placed over the tibial tuberosity, at 3 cm medial to the tibial tuberosity, and at 3 cm distal and 5 cm medial to the tibial tuberosity. An approximately 3.5-cm-long line (representing the incision) was drawn connecting the 2 points located medial to the tibial tuberosity. After incision, the semitendinosus and gracilis tendon bifurcation point locations were measured with an inflexible metric ruler (+/- 0.5 cm) and recorded.
  
  
  RESULTS
  The mean bifurcation point was located 2.2 +/- 0.7 cm distal and 4.5 +/- 0.6 cm medial to the tibial tuberosity, directly on the proposed incision line. All bifurcation points were located within +/- 2 cm of the proposed incision.
  
  
  CONCLUSIONS
  The traditionally used incision line is, on average, located 2 cm too lateral to the bifurcation point and in some cases may be located 3 to 4 cm too lateral, making tendon harvest more difficult and more likely to cause harvest-induced injury to adjacent tissues.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Tillett
authors.forename: Robin
authors.initials: R
authors.lastname: Madsen
authors.forename: Rainie
authors.initials: R
authors.lastname: Rogers
authors.forename: John
authors.initials: J
authors.lastname: Nyland
mesh_terms: D002102:Cadaver; D006801:Humans; D066298:In Vitro Techniques; D007719:Knee Joint / Q000033:anatomy & histology / Q000601:surgery; D013710:Tendons / Q000033:anatomy & histology* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods