J Knee Surg 2016; 29(01): 080-083
DOI: 10.1055/s-0034-1398372
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Avoiding Anomalous Tendon Harvest at the Pes Anserinus Insertion

Krishna R. Cidambi
1   Department of Orthopedic Surgery, University of California San Diego, San Diego, California
,
Andrew T. Pennock
1   Department of Orthopedic Surgery, University of California San Diego, San Diego, California
2   Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California
,
Jerry R. Dwek*
3   Department of Radiology, Rady Children's Hospital, San Diego, California
,
Eric W. Edmonds
1   Department of Orthopedic Surgery, University of California San Diego, San Diego, California
2   Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California
› Author Affiliations
Further Information

Publication History

21 May 2014

17 November 2014

Publication Date:
03 January 2015 (online)

Abstract

The purpose of this study was to identify the frequency and characteristics of anomalous pes anserinus tendon morphology in an adolescent population undergoing knee anterior cruciate ligament (ACL) reconstruction surgery. The records of all children who underwent ACL reconstruction surgery at our tertiary care children's hospital from June 2008 through February 2012 were reviewed. Operative reports were reviewed for any indication that an anomaly existed in the pes anserinus or that there was difficulty harvesting the required tendons. Magnetic resonance imaging (MRI) studies were then reviewed for these patients looking for evidence of any anomaly within the pes anserinus structures. Retrospective review was performed on 123 children (mean age, 16.1 years). Three girls (mean age, 16.2 years) were identified as having a low-lying muscle belly and accessory tendon when attempting to harvest the gracilis tendon. Proximal exploration of this short tendon conjoining the gracilis insertion revealed a muscle belly approximately 5 cm from its insertion in the pes anserinus. This anomaly was present in 2.4% of the cases. Based on previous literature, the anomalous muscle present in our cohort could be sartorius or semimembranosus. MRI analysis suggests that the accessory muscle and tendon could be an aberrant strip of the semimembranosus tendon, an anomalous tendon and muscle belly of the gracilis, or a thickening and separation of the sartorius tendon. Anomalous pes anserinus tendons were found to exist in 2.4% of our adolescent study population. At the time of surgery, if a tendon is harvested with a very low-lying muscle belly (with less than 6 cm of tendon), then the presence of an aberrant tendon should be considered. Preoperative MRI may provide evidence of an anomalous tendon if that information is sought.

* The author name Jerry R. Dwek has been corrected as per the erratum published online on March 13, 2015 (doi: 10.1055/s-0035-1549101).


 
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