Abstract
Proximal hamstring tears are common among athletes, especially in sports involving
eccentric lengthening during forced hip flexion and knee extension, such as hurdles
or water skiing. Tears are described by timing (acute [<1 month] or chronic) and severity
(partial or complete). Complete tears are easily identified with magnetic resonance
imaging; however, partial tears may be subtle and potentially missed. The spectrum
of pathology associated with acute injuries ranges from minor strains to complete
tears or avulsions. Acute tears commonly present as pain and bruising over the posterior
thigh along with weakness with active knee flexion and often a sensation of instability
of the lower extremity. Chronic injuries typically present with ischial pain associated
with repetitive activities, and the spectrum includes chronic tendinopathies, ischial
bursitis, partial tears, and nonoperatively treated complete tears. Nonoperative treatment
is recommended in the setting of low-grade partial tears and insertional tendinosis.
However, failure of nonoperative treatment of partial tears may benefit from surgical
debridement and repair. Further, surgical repair of complete tears with retraction
is usually recommended for active patients. Historically, surgical treatment has been
limited to open surgical approaches, although endoscopic management of proximal hamstring
tears and chronic ischial bursitis is an option. Our endoscopic technique employs
the use of two anchors, double loaded with high-strength suture, and may support a
faster recovery due to decreased surgical morbidity. It is important to note that
some patients may not be candidates for this endoscopic repair as a result of several
factors, including prior chronic and retracted tears, as well as those with altered
regional tissue planes due to prior surgical repair.
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Article info
Footnotes
The authors report the following potential conflicts of interest or sources of funding: C.A.G. reports personal fees from Conmed, other from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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