Anterior cruciate ligament (ACL) reconstruction commonly involves the use of hamstring tendon grafts, which are associated with a risk of saphenous nerve injury, particularly the infrapatellar branch. These injuries can lead to sensory disturbances, including numbness, dysesthesia, and chronic pain, significantly impacting patient outcomes. With the growing use of minimally invasive techniques, understanding how to avoid iatrogenic saphenous nerve injuries during tendon harvesting is critical for optimizing surgical success. This narrative review aims to summarize the current techniques for minimizing saphenous nerve injuries during hamstring tendon harvesting and provide practical recommendations based on existing literature. The review explores various surgical approaches, including different incision placements, tendon harvesting techniques, and innovative minimally invasive methods. Studies were selected based on their focus on reducing nerve injuries, with special emphasis on randomized controlled trials, technical notes, and case series. Techniques such as oblique and modified oblique incisions, posterior mini-incisions, and endoscopic harvesting have demonstrated reduced rates of saphenous nerve injury compared to traditional vertical or transverse incisions. Posterior and popliteal fossa approaches, in particular, showed a significant decrease in injury rates, while endoscopic harvesting further minimizes soft tissue damage. However, limitations include anatomical variability and the technical difficulty of some approaches. To minimize the risk of iatrogenic saphenous nerve injury during hamstring tendon harvesting, surgeons should consider using oblique or posterior incisions, opt for minimally invasive or endoscopic techniques when possible, and tailor their approach to the patient’s anatomy. Further research into nerve mapping and long-term outcomes of these methods is needed to refine current practices.