The Hamstring Donor Site Delivery Tube allows a surgeon to directly administer an anesthetic after autograft hamstring harvest during ACL reconstruction. The overall length of the tube is 247 mm. The distal 90 mm features 16 fenestrations in an offset pattern to deliver the anesthetic effectively over a wide area.

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Knee Next Generation in Repair and Reconstruction

The Hamstring Donor Site Delivery Tube assists in delivering an anesthetic to the donor site. It is 24 cm in length with fenestration in an offset pattern to deliver a fluid effectively.

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Hamstring Donor Site Delivery Tube

Tal S. David, MD, (San Diego, CA) demonstrates how the Hamstring Donor Site Block Delivery Tube is used to deliver a bolus of medication to a hamstring harvest site for pain management.

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

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Hamstring Donor Site Delivery Tube with Anterior Hamstring Harvest

I'd like to introduce you to Arthrex hamstring donor site delivery tube. This is a 9.5in cannula. Measures 2.4mm outer diameter, has an inner diameter of 1.1mm, and can be very effective in delivering medication, cell therapy, and any other block type of modality into the area of the hamstring harvest site. It has a lock on one end that easily fits any size syringe, and the other end is fenestrated. There are 16 fenestrations around and spaced throughout the tip of this cannulated tube, so that the material delivered into the hamstring donor site can be easily diffused throughout the area. We're going to review just a standard hamstring harvest for ACL reconstruction. This is usually performed using some simple external landmarks. Tibial tuberosity is one of the easiest landmarks of the knee to find. Pez. Insertion of the semitendinosus and gracilis usually occurs about 5 to 7cm distal to the medial joint line, so the incision is generally based superiorly at the aspect of the tibial tuberosity, and then is carried inferiorly about two centimeters, depending on how much space you need to get these tendons. So we'll make a standard incision down through the soft tissue. Once this incision is made, I carry it down to the pezze fascia, which you can see here. And I can use my finger to kind of run north and south along that pezze fashion. I can feel the rolled edge of the gracilis and Semitendinosus. That way I know exactly where I need to be before I start to split that bursal tissue. So once we're down to the Bursa, you can take a hemostat and I usually use my finger, but you can see the rolled edge of that leading edge of the semitendinosus and gracilis. The gracilis is the more proximal one. The sartorius is even more proximal. We generally don't use that one because it's got a very short tendon. So the gracilis is the first tendon that you can feel it's rolled up. I'm on the superior edge of the gracilis here. And then you can feel a bit of a RAF. And then the Semitendinosus is generally larger, more distal. And that's the inferior border of the semitendinosus. What I like to do is take a 15 blade and split the Bursa longitudinally, and then through that split, I can fish out the tendon, that I can fish out the gracilis superiorly, and I can fish out the semitendinosus inferiorly. Now I've split the Bursa. I've got the semitendinosus inferior to my instrument, and I've got the gracilis superior to my instrument, and I'll fish it out. And as I do that, I try to bring my instrument out between the fascia and the tendon. Preserving the fascia in place makes it much easier to close this fascia later, and also can help restore the length tension relationship of your hamstring after harvest. Once I've released the tendon from the surrounding Bursa, you can see as I pull on it, I get a nice springy, rubbery end feel to it. And that's what you want to feel before even putting a stripper in. You really want to make sure that you've got the adhesions released. Otherwise it can be harder to harvest this tissue and you have a higher chance of amputating it. You usually have these adhesions, and you can see here a typical inferior adhesion of the semitendinosus. Tendinosis. And so by delivering that tendon to me, I can make sure that I release it and not the tendon. Once I have control of this tendon, I can use my finger. I can kind of bluntly peel off any other adhesions. If I feel any adhesions, I can cut them with a metzenbaum's. Once I get this tendon ready for stripping, as I pull on it, I can really feel that all I'm doing is just pulling directly on that musculotendinous unit, and then I know I'm ready to strip it. The other advantage of of using it, of leaving the tendon inserted on the tibial periosteum, is that I don't have to worry about pulling against suture and potentially losing my tendon as I'm driving to, to spread it this way. So if I push forward and my finger slips out, I still have control in this tendon is not going to go anywhere because I've left the insertion intact. So I'll have nice tension on my tendon, and I make sure that that the stripper is completely surrounding the tendon itself. I'm not splitting the tendon, and I'll drive it carefully and slowly, and I'm keeping tension on my on my tendon in his hand. And he gets to the point where you get to the musculotendinous Junction, and then you kind of feel a little pressure and then it becomes much easier to drive this through. Then I can feel the resistance is removed once I get to the muscle belly itself. And as I gently pull on this, my tendon is delivered. If you find yourself with a tendon that's a little short, you can also you can sometimes get an extra even two centimeters of tendon length by just doing a simple subperiosteal dissection. And as I kind of release the tendon. I do so right off the tibia. And as I come up right onto the crest, I can sometimes extend the length of my tendon, because even another ten millimeters can sometimes make a difference and make it easier to whipstitch this tendon. So one of the most important things we try to do after ACL reconstruction is control pain. And we're very effective at controlling anterior pain and even intra-articular pain by injecting intra-articular medication by performing regional nerve blocks, there's not a great way for us to block or control pain in the area of the hamstring harvest, and Arthrex has developed a method for us to be able to deliver a bolus of medicine. Oftentimes this would be something like a long acting Marcaine could even be PRP, any type of cell therapy we're trying to introduce into this area. It allows us through this delivery system to introduce a fenestrated cannula. So in terms of introducing the delivery tube with an assistant holding an Army Navy in place, you can very easily introduce this tube a traumatically because of this atraumatic tip into the bed of the hamstring. Follow it up. It's 9.5in, so it lets you get up as high as you need to get. And once this is in there, I can take my medication. I can introduce it through a simple luer lock and bolus the back of the hamstring. The advantage here is that the tip of this of this tube is fenestrated, so it doesn't just come out of the tip, it actually comes out of the wall of the tube itself. These fenestrations allow you to kind of sprinkle whatever medication you're injecting into the surrounding muscle belly in the area from which the heart, the tendon, was harvested. So we're going to introduce into this harvest site a bolus of bolus of methylene blue. And that will allow us to demonstrate where the injectable actually sits within the hamstring bed. One of the other advantages of this delivery tube is that its inner. Its inner cannula is only 1.1mm, so you don't lose volume within the tube itself. And historically, we've been using other devices. Sometimes a yankauer tip, even even a sleeve of a drill guide, and you wind up losing a lot of volume within the tube itself. So if you're using something like PRP, obviously volume becomes very important and you don't want to lose any within the cannula. This image really demonstrates the range of delivery that you can get as a result of using this delivery tube. The Fenestrations allow you to cover a lot of territory without having to move this cannula too much. And unlike other delivery tubes that simply are cannulated and release all of the injectable at the tip because of the fenestrations in this tube, you can see how the injectable is delivered throughout a large bed of tissue.

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Hamstring Donor Site Delivery Tube

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Surgical Technique Videos (1)

Hamstring Donor Site Delivery Tube with Anterior Hamstring Harvest

Surgical Technique Guides (1)

Minimally Invasive Hamstring Graft Harvesting

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Hamstring Donor Site Delivery Tube

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Knee Next Generation in Repair and Reconstruction

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