1. The ‘sentinel’ vessel: an anatomical landmark to identify the pes anserinus during hamstrings harvest for ACL reconstruction
- Author
-
Shreyash M. Gajjar, Chinmay Gupte, Satish Babu, and Hayden G. Morris
- Subjects
Adult ,Male ,musculoskeletal diseases ,Surgical Wound ,Superficial fascia ,Knee Injuries ,Dissection (medical) ,Transplantation, Autologous ,Arthroscopy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Knee ,Orthopedics and Sports Medicine ,Pes anserinus ,Prospective Studies ,Intraoperative Complications ,030222 orthopedics ,Periosteum ,Anterior Cruciate Ligament Reconstruction ,Skin incision ,business.industry ,Hamstring Tendons ,030229 sport sciences ,Anatomy ,musculoskeletal system ,medicine.disease ,Tendon ,body regions ,Saphenous nerve ,Anatomical landmark ,medicine.anatomical_structure ,Athletic Injuries ,Tissue and Organ Harvesting ,Blood Vessels ,Female ,Surgery ,business ,human activities - Abstract
Hamstrings identification and subsequent graft harvest can be made difficult by body habitus and variability in tendon anatomy. We describe a 'sentinel' blood vessel near the insertions of gracilis and semitendinosus to facilitate identification. A prospective study of 100 patients (100 knees) undergoing primary arthroscopic ACL reconstruction (via the anterior approach) with hamstrings graft was conducted. We searched for a 'sentinel' vessel and studied its position, orientation and perpendicular distance from the pes tendons. The 'sentinel' vessel was present in 98/100 knees. It passed from the superficial fascia to the periosteum at the pes insertion at a mean perpendicular distance of 8 mm from the upper border of the pes tendons. The 'sentinel' vessel was a consistent anatomical finding and served as a reliable guide in determining the pes insertion. Identifying this anatomical landmark allowed a small skin incision with limited wound dissection minimising risk of injury to the infra-patellar branch of the saphenous nerve.
- Published
- 2019