Reconstruction of Chronic Proximal Hamstring Tear: Description of a Surgical Technique

Grasso, Mackenzie; O’Neill, Conor N.; Constantinescu, David S.; Moatshe, Gilbert; Vap, Alexander R.

doi:10.1016/j.eats.2021.01.028

Cited by 5 publications

(11 citation statements)

References 19 publications

(47 reference statements)

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“… 19 , 20 , 21 , 22 Even though it has its limitations and is a technically demanding surgery, open surgery is still needed for severely retracted complete tears. 6 , 23 Even in the setting of a chronic tears, endoscopic techniques with graft augmentation have been described. 24 , 25 When indicated, earlier surgical repair has proven better outcomes than delayed repair.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Proximal Hamstring Insertion With Sciatic Nerve Neurolysis

Castillo-de-la-Peña

Wong

2022

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Proximal Hamstring Insertion With Sciatic Nerve Neurolysis

Castillo-de-la-Peña

Wong

2022

Arthroscopy Techniques

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“…Allograft augmentation is a viable surgical option with good clinical outcomes. 1-7 Surgical technique includes an extensile incision, sciatic neurolysis and release of tendon from adhesions, preparation of allograft, incorporation of the allograft with the native tendon, and fixation to the ischial tuberosity.…”

Section: Video Transcriptmentioning

confidence: 99%

“…Allograft augmentation is a viable surgical option with good clinical outcomes. [1][2][3][4][5][6][7] Surgical technique includes an extensile incision, sciatic neurolysis and release of tendon from adhesions, preparation of allograft,…”

Section: Video Transcriptmentioning

confidence: 99%

“…Chronic, retracted proximal hamstring ruptures are a challenging problem and can be a significant cause of pain and disability if left untreated. 2 Adhesions and excessive retraction may prevent adequate reduction of the native tendon. Allograft augmentation is a viable surgical option with good clinical outcomes.…”

Section: Video Transcriptmentioning

confidence: 99%

“…While the literature on this topic is fairly limited, studies have shown that results for this procedure are generally favorable. 1-7 Folsom et al 1 looked at 26 patients with complete proximal hamstring ruptures, 5 of which were chronic. They found no significant difference in mean hamstring strength deficits for acute versus chronic tears.…”

Section: Video Transcriptmentioning

confidence: 99%

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Reconstruction of a Chronic, Retracted Proximal Hamstring Rupture Using Achilles Tendon Allograft

Swanson,

Nemec,

Winn

et al. 2024

Video Journal of Sports Medicine

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Background: Chronic, retracted proximal hamstring ruptures are a challenging problem and can be a significant cause of pain and disability if left untreated. Allograft augmentation is a viable surgical option with good clinical outcomes. Indications: Indications are symptomatic patients with chronic hamstring ruptures unable to be primarily repaired. Patients typically present with pain, instability, or lack of push of strength. Technique Description: An L-shaped extensile incision is made at the level of the gluteal crease. The gluteus maximus is retracted proximally. The sciatic nerve is identified, neurolysed, and tagged. Following the release of adhesions of the native tendon and confirmation of the inability to complete a primary repair, the Achilles tendon allograft is prepared. The allograft is incorporated with the native tendon and the subsequent hamstring construct is fixed and reduced to the ischial tuberosity with suture anchors. After copious irrigation, the incision is closed with Monocryl and Dermabond (Johnson and Johnson) and a sterile dressing is applied. The patient is placed in a hip brace locked in extension. Results: In a study by Rust et al, examining 72 patients with proximal hamstring ruptures, patients who underwent allograft reconstruction reported activities of daily living and postoperative sports activity equal to those of chronic repair, and inferior to those of acute repair. However, there were no significant differences between groups for patient-reported outcomes among acute and chronic repairs and allograft reconstruction. Moreover, a systematic review, by Van Der Made et al, published in the American Journal of Sports Medicine, included 13 studies that found that Achilles allograft repair for delayed proximal hamstring repair results in outcomes comparable to acute primary repair. Discussion/Conclusion: Although the literature on chronic proximal hamstring repair is fairly limited, studies have shown that proximal hamstring repair with allograft augmentation can be favorable in symptomatic patients. Allograft augmentation for chronic, retracted proximal hamstring ruptures provides increased functional outcomes in comparison with nonoperative management. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making

et al. 2023

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The purpose of this current concepts review is to highlight the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. Hamstring injuries, which are becoming increasingly recognized, affect professional and recreational athletes alike, commonly occurring after forceful eccentric contraction mechanisms. Injuries occur in the proximal tendon at the ischial tuberosity, in the muscle belly substance, or in the distal tendon insertion on the tibia or fibula. Patients may present with ecchymoses, pain, and weakness. Magnetic resonance imaging remains the gold standard for diagnosis and may help guide treatment. Treatment is dictated by the specific tendon(s) injured, tear location, severity, and chronicity. Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy; adjuncts such as platelet-rich plasma injections are currently being investigated. Operative treatment of proximal hamstring injuries, including endoscopic or open approaches, is traditionally reserved for 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management. Acute surgical treatment of proximal hamstring injuries tends to be favorable. Distal hamstring injuries may initially be managed nonoperatively, although biceps femoris injuries are frequently managed surgically, and return to sport may be faster for semitendinosus injuries treated acutely with excision or tendon stripping in high-level athletes.

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Reconstruction of Chronic Proximal Hamstring Tear: Description of a Surgical Technique

Cited by 5 publications

References 19 publications

Endoscopic Repair of Proximal Hamstring Insertion With Sciatic Nerve Neurolysis

Endoscopic Repair of Proximal Hamstring Insertion With Sciatic Nerve Neurolysis

Reconstruction of a Chronic, Retracted Proximal Hamstring Rupture Using Achilles Tendon Allograft

Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making

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