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Hamstrings graft

A hamstrings graft is a transplant replacing a torn cruciate ligament using one of the hamstrings tendons from the back of the knee - the semi-tendinosis, together with another muscle, the gracilis.

The hamstrings are in fact three individual muscles:

• semi-tendinosus (also called a ‘pes anserine’ tendon)
• semi-membranosus
• biceps femoris

Pes anserine tendons

The stringy semi-tendinosus tendon inserts at the top end of the tibia, together with two other stringy tendons of two other muscles - sartorius and gracilis. Where they attach to the bone they are joined in a web-like structure resembling a goose foot, and hence these are also called the ‘goose-foot’ or pes anserine tendons. The importance of this is that semi-tendinosus and gracilis tendons can be stripped up (’harvested’) from their bony attachment and used to replace the cruciate ligament.

The gracilis is not actually a hamstrings muscle, but an ‘adductor’ muscle, but it is nonetheless harvested routinely for a ‘hamstrings graft’.

The stringy pes anserine tendons are stripped with a special instrument, then sewn together, folded and sewn again, forming a ‘four-strand’ graft which is about as thick as the original cruciate ligament.

This is then used to replace the torn cruciate.