Achilles allograft reconstruction of a chronic complete proximal hamstring rupture

Abstract

Complete rupture of the origin of the hamstrings is an uncommon injury. Primary surgical repair is the treatment of choice, but in some not possible. We present a case of an avid cyclist who had significant disability from a 6-year-old injury. He underwent reconstruction with Achilles allograft and suture anchors. With the knee flexed to 90 degrees and after extensive mobilization, the retracted musculotendinous unit would not reach the ischial tuberosity. Two suture anchors were placed in the ischial tuberosity after soft tissue debridement. One limb of suture from each anchor was placed in the end of an Achilles allograft with a locking suture, with the other end used to pull the end of the graft to the ischial tuberosity. An additional suture was placed in running fashion down each side of the graft. Distally, the graft was fanned out and attached to the retracted hamstrings with interrupted sutures with the knee at 40 degrees and maximal proximal pull on the hamstrings. The patient outcome was excellent. He resumed high level cycling by 6 months after surgery with no symptoms. Isokinetic testing demonstrated a hamstring deficit of 25% at 60 degrees/s, and 20% at 180 degrees/s at 8 months.