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

Proximal hamstring injury represents a spectrum of trauma to either the bone or the soft tissues. Injuries can be complete or incomplete. Complete injuries usually require surgical treatment.We discuss the operative management of eight consecutive cases of chronic complete proximal hamstring injuries (injury to surgery >2.5 months). Of the eight patients, three patients had soft tissue avulsions, which were reattached with anchors via a longitudinal buttock crease incision. Five patients had bony avulsions requiring open reduction and internal fixation. In three of these, the retraction of the fragment into the thigh was so great that it was not easily retrievable and fixable through a conventional approach. On the basis of a cadaveric study, a double-window surgical approach was developed to enable us to treat these avulsions with extreme retraction. This approach can be used for other less severe injuries.