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Updated: Nov 4, 2025

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Endoscopic Approach to Proximal Hamstring Avulsion Repair.

Sunikom Suppauksorn1, Benedict U Nwachukwu2, Edward C Beck3

  • 1Orthopaedic Institute, Lerdsin Hospital, Bangkok, Thailand.

JBJS Essential Surgical Techniques
|May 31, 2021
PubMed
Summary

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Endoscopic repair offers precise anatomical fixation for proximal hamstring avulsions, reducing neurovascular injury risk compared to open procedures. This minimally invasive technique is suitable for specific tear types and retraction amounts.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Minimally Invasive Procedures

Background:

  • Proximal hamstring avulsion repair aims for anatomical accuracy and reduced neurovascular complications.
  • Endoscopic surgery provides superior visualization of the subgluteal space, avoiding gluteus maximus retraction.
  • Open repair risks injury to the inferior gluteal nerve and artery due to muscle mobilization and increases infection risk.

Purpose of the Study:

  • To outline the indications and methodology for endoscopic repair of proximal hamstring avulsions.
  • To compare the advantages of endoscopic repair over open repair and conservative management.
  • To define the feasibility of endoscopic repair based on tear chronicity and tendon retraction.

Main Methods:

  • Endoscopic repair involves two portals (medial percutaneous, lateral direct visualization) for precise tendon fixation.

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  • Careful identification and protection of sciatic and posterior femoral cutaneous nerves are crucial.
  • Suture anchors are used for tendon fixation with the knee in a flexed position.

    • Main Results:

    • Endoscopic repair allows for precise anatomical repair of proximal hamstring avulsions.
    • Minimally invasive approach reduces the risk of neurovascular injury and wound infection.
    • Indications include acute tears with significant retraction or failed conservative treatment for smaller tears.

    Conclusions:

    • Endoscopic repair is a viable, precise, and safe option for proximal hamstring avulsions.
    • The technique is particularly advantageous in minimizing risks associated with open procedures.
    • Patient selection based on tear characteristics is key for successful endoscopic repair.