The ‘sentinel’ vessel: an anatomical landmark to identify the pes anserinus during hamstrings harvest for ACL reconstruction

  • Satish BabuEmail author
  • Chinmay Gupte
  • Shreyash Gajjar
  • Hayden Morris
Original Article • KNEE - ARTHROSCOPY


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.


Sentinel blood vessel ACL Pes anserinus Hamstrings Graft Morbidity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Informed consent

The study was authorised by the local ethical committee and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki as revised in 2000.


  1. 1.
    Solman CG, Pagnani MJ (2003) Hamstrings tendon harvesting: reviewing anatomic relationships and avoiding pitfalls. Orthop Clin N Am 34:1–8CrossRefGoogle Scholar
  2. 2.
    Pagnani MJ, Warner JJP, O’Brien SJ et al (1993) Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med 21:565–571CrossRefGoogle Scholar
  3. 3.
    Warren LF, Marshall JL (1971) The supporting structure and layers on the medial side of the knee. J Bone Joint Surg 61:56–62CrossRefGoogle Scholar
  4. 4.
    Prodromos CC, Han YS, Keller BL et al (2005) Posterior mini-incision technique for hamstring anterior cruciate ligament reconstruction graft harvest. Arthroscopy 21:130–137CrossRefGoogle Scholar
  5. 5.
    Wilson T, Lubowitz J (2013) Minimally invasive posterior hamstring harvest. Arthrosc Tech 2(3):e299–e301CrossRefGoogle Scholar
  6. 6.
    Zaffagnini S, Golano P, Farinas O et al (2003) Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat 16(1):19–24CrossRefGoogle Scholar
  7. 7.
    Mochizuki T, Muneta T, Yagishita K et al (2004) Skin sensory change after anterior cruciate ligament reconstruction using medial hamstrings tendons with a vertical incision. Knee Surg Sports Traumatol Arthrosc 12:198–202CrossRefGoogle Scholar
  8. 8.
    Bertram C, Porsch M, Hackenbroch MH et al (2000) Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis graft. Arthroscopy 16:763–766CrossRefGoogle Scholar
  9. 9.
    Arthornthurasook A, Gaew-Im K (1990) The sartorial nerve: its relationship to the medial aspect of the knee. Am J Sports Med 18:41–42CrossRefGoogle Scholar
  10. 10.
    Arthornthurasook A, Gaew-Im K (1988) Study of the infrapatellar nerve. Am J Sports Med 16(1):57–59CrossRefGoogle Scholar
  11. 11.
    Kartus J, Ejerhed L, Eriksson BI et al (1999) The localization of the infrapatellar nerves in the anterior knee region with special emphasis on central third patellar tendon harvest: a dissection study on cadaver and amputated specimens. Arthroscopy 15:577–586CrossRefGoogle Scholar
  12. 12.
    Portland GH, Martin D, Keene G et al (2005) Injury to the infrapatellar branch of the Saphenous nerve in anterior cruciate ligament reconstruction: comparison of horizontal vs. vertical harvest site incisions. Arthroscopy 21(3):281–285CrossRefGoogle Scholar
  13. 13.
    Papastergiou SG, Voulgaropoulos H, Mikalef P et al (2006) Injuries to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Frimley Park HospitalFrimleyUK
  2. 2.Imperial College Healthcare NHS TrustLondonUK
  3. 3.Kokilaben Dhirubhai Ambani HospitalMumbaiIndia
  4. 4.St. Vincent’s & Mercy HospitalsMelbourneAustralia

Personalised recommendations