Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs.

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Sports medicine

Background:

• Limited biomechanical data exists for proximal hamstring repair anchor constructs.
• Existing literature on shoulder anchors is abundant but not directly applicable.
• Understanding anchor efficacy is crucial for optimizing hamstring repair outcomes.

Purpose of the Study:

• To biomechanically compare the failure load and mechanism of knotless versus knotted anchors in hamstring repair.
• To evaluate the performance of different anchor configurations against intact hamstring tendons.
• To provide data guiding the selection of optimal implants for proximal hamstring repair.

Main Methods:

• Controlled laboratory study using 17 cadaveric hamstring tendons.
• Groups included intact tendons, all-knotted anchors, and all-knotless anchors.
• Cyclic and maximal load-to-failure testing was performed, measuring ultimate load and displacement.

Main Results:

• All-knotless anchors supported the highest maximal load (767.18 N), comparable to intact tendons (750.58 N).
• All-knotless constructs showed significantly higher load to failure than all-knotted constructs (549.56 N).
• Failure modes differed, with knotted repairs failing at the suture-tendon interface and knotless at the musculotendinous junction.

Conclusions:

• Knotless suture anchors provide superior biomechanical performance for proximal hamstring repair compared to knotted anchors.
• The findings suggest knotless anchors may offer a stronger construct, potentially impacting rehabilitation strategies.
• Further research can refine surgical techniques and improve patient recovery after hamstring repair.