Fixation of the Proximal Hamstring Tendon Using an All-Suture Tensionable Knotless Technique

Proximal hamstring injuries are a common sports and recreational injury among the active patient population. Surgical fixation of the tendons of the hamstring muscle complex, as opposed to conservative treatment alone, has shown improved patient outcomes, prompting the evolution of the suture anchors utilized in these repairs. Previous studies investigating the biomechanical properties of hamstring repair anchors have focused on double-row knotless techniques, in which the fixation of the overall construct relies on each individual anchor to maintain fixation. While these constructs have demonstrated biomechanical strength and clinical durability, each suture anchor represents a potential point of failure for the entire construct due to the crossed stitch anchor configuration. To address this limitation, recent tensionable knotless all-suture anchor designs have been implemented with success due to their smaller size and biomechanical strength. The aim of this technical note is, thus, to describe a technique for proximal hamstring repair using a tensionable knotless all-suture anchor construct that has 5 independent mattress sutures and, in doing so, employs the biomechanical strength of knotless fixation but eliminates the potential single point of failure seen with current knotless suture anchor designs.