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Endoscopic Partial Proximal Hamstring Repair

March 01, 2020

Contributors: Dylan Lowe, MD; Thomas Youm, MD, FAAOS; Michael J Moses, MD

Background: Hamstring injuries commonly occur in athletes, with as many as 12% of hamstring injuries localized to the proximal aspect of the muscle and the myotendinous junction. Partial hamstring tears represent a smaller portion of hamstring injuries. Commonly, partial hamstring injuries involve avulsion of the semitendinosus and biceps origin, with the semimembranosus remaining intact. Diagnosis requires a careful patient history and physical examination as well as supportive imaging studies. Patients often will report pain localized to the posterior aspect of the thigh at the insertion of the hamstring on the ischial tuberosity. Patients also may have point tenderness at this location. Careful assessment of hip range of motion and neurovascular function is required. Radiographs demonstrating an avulsion fracture or MRI revealing tendinous or muscle disruption aid in management. Partial hamstring injuries may appear subtle on imaging studies; however, edema and the classic sickle sign may be observed. Partial hamstring injuries are managed nonsurgically via rest, physical therapy, and NSAIDs or surgically, depending on the injury grade and associated symptoms. Surgical repair should be considered in patients in whom 3 to 6 months of nonsurgical treatment fails to alleviate symptoms. Endoscopic repair is as a safe and viable technique for the repair of partial proximal hamstring injuries. Careful technique is essential to prevent poor outcomes and ensure consistent results. Purpose: This video demonstrates a technique for endoscopic repair of a partial proximal hamstring tear. Methods: An overview of the anatomy, diagnosis, and management of partial proximal hamstring injuries is provided, followed by a discussion of the indications for endoscopic hamstring repair. The case presentation of a 45-year-old woman with 7 months of left hip pain is discussed. Her hip pain was localized to the posterior aspect of the proximal thigh and impaired her function as a fitness instructor. Physical examination revealed tenderness at the ischial tuberosity. Pain with flexion of the hip beyond 100° also was noted. MRI of the left lower extremity revealed a high-grade partial proximal hamstring tear. Endoscopic repair of the partial proximal hamstring injury was indicated. Results: Excellent restoration of left hip function was achieved postoperatively. The patient was advanced through a standardized rehabilitation protocol, which resulted in gradual relief of her symptoms. Conclusion: Endoscopy is an effective treatment option for the management of partial proximal hamstring injuries. Surgical management requires adequate exposure and familiarity with the anatomy of the lesion based on preoperative imaging studies. Limited data are available on outcome measures; however, results are contingent on careful and consistent technique, which is reviewed in the video.

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