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Proximal Hamstring Reconstruction with Achilles Allograft and Sciatic Neurolysis

February 10, 2018

Contributors: Jared Bookman, MD; Amos Dai, BS; Dylan Lowe, MD; Thomas Youm, MD, FAAOS; Thomas Youm, MD, FAAOS

Purpose: Avulsion of the proximal origin of the hamstring has become a more frequently recognized athletic injury. Most injuries are partial strains. Complete rupture is relatively uncommon but may cause considerable functional impairment. Primary repair is the preferred treatment option for patients with an acute injury. However, in patients with a chronic injury, the proximal muscle mass often is retracted, and reconstruction is the only viable surgical option. Orthopaedic surgeons rarely perform surgery in this anatomic area. This video demonstrate a technique for proximal hamstring reconstruction with the use of Achilles tendon allograft and sciatic neurolysis. Methods: The video presents the case study of a 29-year-old woman who injured her left hamstring 3 years ago when she did a split while rollerblading. Her pain is persistent, located in the left buttock, worse with running and any athletic activity, and has been refractory to nonsurgical management. MRI revealed a complete tear of the proximal hamstring origin, which is extensively scarred and retracted 11 cm. The video reviews the patient history, imaging studies, and indications for surgery and details a technique for proximal hamstring reconstruction. The video focuses on methods for reconstructing the tendon and safe exposure and neurolysis of the sciatic nerve. Results: After the procedure, the video reviews the postoperative protocol for the patient. In addition, literature on the outcomes of proximal hamstring reconstruction is reviewed. In general, limited data suggest successful functional outcomes after reconstruction; however, these outcomes are inferior to those of acute repair. Conclusion: Complete, chronic proximal hamstring tears may cause considerable pain and persistent functional limitations. These tears are more technically difficult to manage because of tendon retraction and scarring; however, they can be managed via reconstruction with the use of Achilles tendon allograft and sciatic neurolysis.

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