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Proximal Hamstring Tears: Endoscopic Hamstring Repair.

William Arroyo1, Carlos A Guanche2

  • 1Southern California Orthopedic Institute, Van Nuys, California, U.S.A..

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|November 6, 2021
PubMed
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Proximal hamstring tears, common in athletes, range from partial to complete tears. Endoscopic repair offers a minimally invasive option for active patients with significant tears, potentially aiding faster recovery.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Musculoskeletal Imaging

Background:

  • Proximal hamstring tears are prevalent in athletes participating in sports requiring eccentric lengthening during hip flexion and knee extension.
  • Tears are classified by timing (acute vs. chronic) and severity (partial vs. complete), with partial tears often being subtle and challenging to diagnose.
  • Acute injuries present with posterior thigh pain, bruising, weakness, and instability, while chronic injuries manifest as ischial pain from repetitive activities.

Purpose of the Study:

  • To review the diagnosis and management spectrum of proximal hamstring tears.
  • To discuss the indications for operative versus nonoperative treatment for acute and chronic proximal hamstring injuries.
  • To present an endoscopic surgical technique for proximal hamstring tear repair.

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Main Methods:

  • Review of current literature on proximal hamstring tear pathology, diagnosis, and treatment options.
  • Description of clinical presentation and diagnostic modalities, including MRI for subtle partial tears.
  • Detailed explanation of an endoscopic surgical technique utilizing double-loaded anchors and high-strength suture.

Main Results:

  • Nonoperative treatment is suitable for low-grade partial tears and insertional tendinosis.
  • Surgical intervention, including debridement and repair, is beneficial for failed nonoperative cases of partial tears and complete tears with retraction in active patients.
  • The described endoscopic technique may facilitate a quicker recovery due to reduced surgical morbidity compared to open approaches.

Conclusions:

  • Proximal hamstring tears require accurate diagnosis, with partial tears posing a diagnostic challenge.
  • Treatment strategies range from conservative management to surgical repair, tailored to tear severity and chronicity.
  • Endoscopic repair presents a viable, potentially faster-recovering alternative for select patients with proximal hamstring tears.