Hamstring graft constructs

The semitendinosus, sometimes combined with the gracilis, is harvested through a small medial incision and folded to form a multi-strand graft.

Common constructs include the semitendinosus and gracilis doubled to create four strands, or the semitendinosus alone folded into four strands. Ask exactly which construct is being considered.

This option avoids bone harvesting and generally causes less anterior knee pain when kneeling than the patellar tendon.

The harvest scar is often limited, but the outcome depends on the fixation and the diameter obtained.

A deficit in deep flexion or hamstring strength may persist, especially early on. Saphenous nerve irritation may create a small area of numbness.

For some young high-risk athletes, the choice and potential lateral procedures are discussed with nuance.

Mention any sports or tasks that require sprinting, braking, or loaded knee flexion. This information does not rule out this graft but helps anticipate recovery priorities.

Ask if the graft diameter is evaluated, which construct is planned, and how the harvest site will be monitored.

• Report any history of hamstring injury.
• Ask how flexion strength will be monitored.

Hamstrings are involved in knee flexion and the control of certain tibial stresses. After harvesting, their recovery is not limited to a subjective feeling of strength; deep flexion, explosive movements, and coordination may be affected. These considerations guide the follow-up but do not allow one to conclude that a graft is unsuitable for a sport without a complete examination.

Ask whether the semitendinosus alone or a combined semitendinosus–gracilis graft is planned, how the graft diameter is managed, and which tests will be used to monitor posterior thigh function. Report any medial leg irritation or sensory disturbance after the procedure.

These benchmarks serve to prepare for a clinical discussion and to understand the possible choices. They do not allow one to conclude anything remotely about an injury, treatment, or schedule: the context, the examination, and any associated procedures remain decisive.

To delve deeper into "Hamstring graft constructs," revisit the elements of the sections "Which tendons are used?" and "Potential advantages" with your own timeline. It is useful to separate what is certain—date of trauma, report, triggering activity—from what remains an impression, such as a feeling of weakness or giving way. This distinction makes the information easier for the team to interpret.

The cited publications describe populations and trends; they do not replace the instructions of the team that knows your file. During the consultation, ask how general information applies or does not apply to your situation, what its limitations are, and what sign would justify making contact before the scheduled follow-up.

After the discussion, note the next step, the person to contact, and the symptoms to monitor. If a response seems contradictory to a report or written instruction, ask for clarification rather than changing weight-bearing, activities, or medications on your own.

• Aspetar 2023. Clinical Practice Guideline on Rehabilitation after ACL reconstruction.
• AAOS 2022. Management of Anterior Cruciate Ligament Injuries — Clinical Practice Guideline.
• BJSM 2022. OPTIKNEE consensus recommendations to optimise knee health after traumatic knee injury.
• Persson 2020. Hamstring tendon autografts are associated with a higher revision rate than patellar tendon autografts.