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Optimization of surgical exposure for harvesting gracilis-semitendinosus tendons

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Abstract 

Purpose

This study was conducted to provide anatomical data and surface markers for the safe and efficient exposure of surgical incisions for harvesting gracilis tendons (GT) and semitendinosus tendons (STT) while avoiding technical pitfalls and nerve injury during harvest for ligament reconstruction.

Methods

Seventy-four Chinese cadaveric lower limbs were dissected to expose the infrapatellar branch of the saphenous nerve (IPBSN) and pes anserinus (PA). Measurements of the borders and accessory bands of the PA tendons were taken. The arrangement of PA tendons and distribution of the IPBSN were assessed.

Results

The PA was roughly shaped like a quadrangle, with its superior border at the horizontal plane of the tibial tuberosity (TT). The GT and STT bifurcation point was located on the medial border of the PA. From medial side to lateral side, the sartorius tendons (ST), GT, and STT fused gradually and formed the lateral border of the PA at the distal end. The tendon arrangement of the PA was primarily affected by ST, which commonly covered GT and STT completely. Variant tendons were found in 41.9% of specimens. The insertion of the accessory bands was distal but close to the inferior border of the PA. Accessory bands were observed only in STT and ST, and STT accounted for the most. The width of the first accessory band of STT was similar to the width of the STT. Additionally, most of the IPBSNs were proximal to the horizontal plane of the TT.

Conclusion

For clearly exposing the GT and STT, it is crucial to expose the GT and STT bifurcation point on the medial border of the PA, whether directly or indirectly through the incision.The influence of ST insertion and the variability of tendons within the PA must be paid attention to during the operation. To protect IPBSNs highly, the incision should not be higher than the TT level.

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Funding

The study was financially supported by the National Natural Science Foundation of China (81802172, 82172416), Guangdong Basic and Applied Basic Research Foundation (2021A1515012337, 2019A1515011684), Natural Science Foundation of Guangdong Province (2017A030313854), and Guangdong Science and Technology Collaborative Innovation Center for Sports (2019B110210004). We thank medical illustrator Deng Yuan for making illustrations.

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Authors and Affiliations

  1. Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 West Yanjiang Road, Guangzhou, 510120, People’s Republic of China

    Jialong Luo, Bin Song & Chuan Jiang

  2. Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan Er Road, Guangzhou, 510062, People’s Republic of China

    Jialong Luo, Shuzhen Li, Chenyu Wang, Qibo Li, Jianghua Lin, Yuan Shen, Yuchen Wang & Dazheng Xu

Authors
  1. Jialong Luo
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  2. Shuzhen Li
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  3. Chenyu Wang
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  4. Qibo Li
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  5. Jianghua Lin
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  6. Yuan Shen
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  7. Yuchen Wang
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  9. Bin Song
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  10. Chuan Jiang
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Contributions

Jialong Luo: conceptualized the study, designed the research, performed the experiments, interpreted the data, wrote the manuscript, and submitted the manuscript. Shuzhen Li: designed the research, performed the experiments, interpreted the data, and wrote the manuscript. Chenyu Wang: designed the research, performed the experiments, and wrote the manuscript. Qibo Li: designed the research, performed the experiments, and wrote the manuscript. Jianghua Lin: designed the research, performed the experiments, and wrote the manuscript. Yuan Shen: designed the research, performed the experiments, and wrote the manuscript. Yuchen Wang: designed the research, performed the experiments, and wrote the manuscript. Dazheng Xu: designed the research, performed the experiments, and wrote the manuscript. Bin Song: donceptualized the study, designed the research, and wrote the manuscript. Chuan Jiang: conceptualized the study, designed the research and wrote the manuscript.

Corresponding authors

Correspondence to Bin Song or Chuan Jiang.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University.

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The authors declare no competing interests.

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Luo, J., Li, S., Wang, C. et al. Optimization of surgical exposure for harvesting gracilis-semitendinosus tendons. International Orthopaedics (SICOT) 47, 131–140 (2023). https://doi.org/10.1007/s00264-022-05598-5

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  • DOI: https://doi.org/10.1007/s00264-022-05598-5

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