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# Gracilis tendon

The gracilis tendon is a thin tendon on the inner knee that joins the pes anserinus; it is often used as a graft to rebuild the ACL.

Official name: Tendon of gracilis

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## What it is

A thin tendon on the inner knee, from the [gracilis muscle](https://durgical.com/en/anatomy/gracilis-muscle/). It ends on the inner [tibia](https://durgical.com/en/anatomy/tibia/) next to the semitendinosus.

## What it does

Helps bend the knee and turn the shin inward; supports the knee from the inner side.

## Key points

- Thinner than the [semitendinosus](https://durgical.com/en/anatomy/semitendinosus-muscle/) and lying just above it at the pes anserinus; both run deep to the sartorius fascia, where they are found for graft harvest
- Besides the ACL, it is a common graft for [medial patellofemoral ligament](https://durgical.com/en/anatomy/medial-patellofemoral-ligament/) (MPFL) reconstruction and for some collateral ligament reconstructions
- The [saphenous nerve](https://durgical.com/en/anatomy/saphenous-nerve/) becomes subcutaneous between this tendon and the sartorius at the medial knee

## Key facts

**Attaches**
Pes anserinus on the upper medial tibia, between the sartorius (in front) and the semitendinosus (below)

**Function**
Knee flexion and medial rotation; hip adduction; often harvested with the semitendinosus as a hamstring graft for ACL reconstruction

**Tight in**
Hip abduction with the knee extended

## Relations

**Course**
Down the medial thigh as a thin strap, becoming a round tendon above the knee; passes behind the medial femoral condyle and curves forward to the pes anserinus

**Superficial**
[Sartorius](https://durgical.com/en/anatomy/sartorius-muscle/) aponeurosis

**Below**
[Semitendinosus tendon](https://durgical.com/en/anatomy/tendon-of-semitendinosus/), just below and behind it, often linked to it by fibrous bands

**Deep**
Superficial MCL, separated from it by the [pes anserine bursa](https://durgical.com/en/anatomy/anserine-bursa/)

## How to find it

With the knee bent against resistance, two cords stand out at the back of the inner knee: the bigger, more posterior one is the semitendinosus, and the thinner one just in front of it is the gracilis; spreading the thighs apart makes the gracilis stand out more.

## On imaging

On axial MRI at the knee it is a small round dark dot between the sartorius in front and the semitendinosus behind; after harvest it is missing or replaced by scar.

## Common problems

- Strains or tendinitis, mostly in sports with sprinting or kicking.
- It is one of the most common graft sources for ACL reconstruction; the leg usually adapts well.

## How it is diagnosed

Physical exam; ultrasound or MRI if needed.

## Treatment

- Rest, ice and progressive physical therapy.
- Used as a tendon graft in ACL reconstruction.

## Clinical notes

- Harvest can injure the infrapatellar branch of the saphenous nerve, leaving numbness below and in front of the knee
- After taking both the gracilis and the semitendinosus, the strength loss is mostly in deep knee flexion and is usually small

## Test yourself

Think of the answer, then tap the question to see it.

## Where does the gracilis tendon lie at the pes anserinus?

Between the sartorius in front and the semitendinosus below, deep to the sartorius fascia.

## For which reconstructions is the gracilis tendon a common graft?

ACL reconstruction (with the semitendinosus), MPFL reconstruction and some collateral ligament reconstructions.

## Between which two tendons does the saphenous nerve become subcutaneous at the medial knee?

Between the gracilis tendon and the sartorius.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
musculus gracilis TA2 2635

**Official Spanish (DeCS)**
Tendón del recto interno DeCS D013710

**English (TA2)**
Tendon of gracilis

## Related

- [Sartorius tendon](https://durgical.com/en/anatomy/tendon-of-sartorius/)
- [Semitendinosus tendon](https://durgical.com/en/anatomy/tendon-of-semitendinosus/)
- [Gracilis](https://durgical.com/en/anatomy/gracilis-muscle/)
- [Femur](https://durgical.com/en/anatomy/femur/)
- [Hip bone](https://durgical.com/en/anatomy/hip-bone/)
- [Tibia](https://durgical.com/en/anatomy/tibia/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=14088); [Anatomy, Bony Pelvis and Lower Limb: Thigh Gracilis Muscle](https://www.ncbi.nlm.nih.gov/books/NBK538229/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/tendon-of-gracilis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/tendon-of-gracilis/