Endoscopic repair of proximal hamstring avulsion

Abstract

Hamstring muscle injuries are common in athletes and mostly consist of sprains at the myotendinous junction, which often respond well to conservative treatment. Proximal hamstring avulsion injuries, though less common, can be severely debilitating. This injury is often seen in water skiers but has been described in many other sports and in middle-aged patients. Complete avulsions in young and active individuals do not respond well to conservative treatment and may require surgical repair. In contrast, many partial tears may be treated nonoperatively. However, when symptoms continue despite a trial of extensive therapy, surgery may be warranted. Traditional surgery for proximal hamstring repair is performed with the patient in the prone position with an incision made longitudinally or along the gluteal fold, followed by identification of the torn tendons and fixation to the ischial tuberosity. We describe a novel surgical technique for endoscopic repair of proximal hamstring avulsion injuries.

Fig 1

The patient is in the prone position for a right proximal hamstring endoscopic repair. Anatomic landmarks and portal positions are marked, and the patient is prepared and draped.

Fig 2

Endoscopic view from the lateral portal after hamstring bursectomy, showing identification and protection of the sciatic nerve (asterisk). The patient is in the prone position.

Fig 3

Endoscopic view from the lateral portal showing partial tear of the proximal hamstring origin. The asterisk indicates the ischial tuberosity; the plus sign indicates the hamstring tendons. The patient is in the prone position.

Fig 4

Endoscopic view from the lateral portal showing insertion of a 5.5-mm polyetheretherketone screw (Arthrex) to the footprint of the proximal hamstring. The footprint has been cleared of soft tissue, and a bed of bleeding was created using a burr to facilitate tendon-bone healing. The asterisk indicates the ischial tuberosity. The patient is in the prone position.

Fig 5

Endoscopic view from the lateral portal showing mattress sutures passed through the tendon. The asterisk indicates the ischial tuberosity; the plus sign indicates the hamstring tendons. The patient is in the prone position.

Fig 6

Endoscopic view from the lateral portal showing the final repair of the proximal hamstring origin. The asterisk indicates the ischial tuberosity; the plus sign indicates the hamstring tendons. The patient is in the prone position.