The “Motionless Gastrocnemius”: A Reliable Sign for Safe Graft Harvesting

Abstract

Difficulties in graft harvesting of the hamstring have been the topic of many studies. These difficulties are related to the aponeurotic or fibrous attachments of the hamstrings with the medial head of the gastrocnemius muscle, soleus muscle, and leg fascia. Freeing the graft from these attachments is important because insufficient release prior to stripper insertion can lead to premature transection or amputation. We describe a reliable intraoperative physical examination sign to help understand the sufficient amount by which a tendon graft needs to be released prior to stripper insertion. The presence of the motionless gastrocnemius (“motionless gastroc”) phenomenon is used in our clinic as a sign that the grafts have been sufficiently freed and that a tendon stripper can be used without fear of transection or graft amputation.

The adductor magnus tendon is a viable option for medial patellofemoral ligament reconstruction, but with a busy surrounding neurovascular topography

“…Harvesting and reconstruction using an ADM tendon was first described as an open procedure, which is also the safest one [6]. While blunt finger dissection might be sufficient for freeing other grafts [3], visualization and sharp dissection might be required to free the ADM tendon proximally [6, 9]. Clinical experience has shown that using a stripper that allows to cut the tendon at a desired length is safer and has been shown to minimize complications [6, 7] and that direct visualization of the tendon (through a camera or by a bigger incision) together with the stripper allows for accurate visualization of surrounding structures and could potentially prevent injury to neurovascular structures.…”