Endoscopic Repair of a Partial Undersurface Proximal Hamstring Tendon Tear

Proximal hamstring tendons are commonly injured among athletes, and when tendon tears are indicated for surgery, the gold standard has been open repair with suture anchors. However, endoscopic repair techniques like the technique described in this study for hamstring undersurface concealed crescentic injuries (HUCCIs) have been shown to have high patient satisfaction and limit perioperative complications.

General indications for surgery for hamstring tears are 2-tendon, partial tears with >2 cm of retraction or 3-tendon complete tears that have been recalcitrant to nonoperative treatment. This technique focuses specifically on the repair of partial undersurface tears of hamstring tendons that are often concealed by partially intact superficial tendon tissue.

This technique guide describes a minimally invasive endoscopic technique for repairing proximal HUCCIs using 4 interlinked knotless suture anchors to create an X-formation repair construct. Patients are positioned prone with the operative leg resting on a Mayo stand to help extend and abduct the leg during the procedure. Two portals are used primarily, one in the distal gluteal crease and another proximal lateral portal used primarily for anchor placement. Sciatic nerve identification, neurolysis, and mobilization are performed under direct visualization. The undersurface injury is identified, bursectomy is performed, and a split is made in the interval between the conjoint tendon and semimembranosus. Through the interval, the ischial tuberosity is decorticated, and 4 interlocked, knotless anchors are used to create the HUCCI-X repair.

Patients treated with endoscopic proximal hamstring repairs generally have significant improvement in patient-reported outcome metrics equivalent to open repair techniques. In the literature, return to sport after endoscopic proximal hamstring repairs has ranged from 77% to 95%.

The HUCCI-X repair technique offers a novel, safe, and effective way to repair undersurface proximal hamstring tears endoscopically. This technique combines the benefits of a minimally invasive endoscopic hamstring repair, including lower perioperative complications, with the compressive force of "suture staples" created by interlinked knotless suture anchors. Future studies may focus on patient postoperative outcomes after treatment with this technique.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.