Chronic complete proximal hamstring injury: The double-window approach for bony avulsions

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Traumatology

Background:

• Proximal hamstring injuries encompass bone or soft tissue trauma, ranging from incomplete to complete tears.
• Complete proximal hamstring injuries often necessitate surgical intervention for optimal outcomes.
• Chronic injuries, defined as occurring more than 2.5 months post-trauma, present unique management challenges.

Purpose of the Study:

• To describe the operative management of eight consecutive cases of chronic complete proximal hamstring injuries.
• To introduce and evaluate a novel double-window surgical approach for complex bony avulsions with extreme retraction.

Main Methods:

• Review of eight patients with chronic complete proximal hamstring injuries.
• Surgical techniques included soft tissue reattachment with anchors and open reduction internal fixation for bony avulsions.
• Development and application of a double-window surgical approach for cases with significant fragment retraction, informed by cadaveric studies.

Main Results:

• Three patients with soft tissue avulsions were treated with anchor reattachment.
• Five patients with bony avulsions underwent open reduction and internal fixation.
• Three of the bony avulsion cases required the novel double-window approach due to extreme fragment retraction, demonstrating its efficacy.

Conclusions:

• Both soft tissue and bony proximal hamstring avulsions can be effectively managed surgically.
• The developed double-window surgical approach offers a viable solution for complex bony avulsions with extreme retraction.
• This approach may also be applicable to other proximal hamstring injuries with less severe retraction.