17:25
Published March 01, 2019

Proximal Hamstring Tears: From Anatomy to Surgical Repair

2019 AWARD WINNER

Hamstring injuries are very common in individuals who participate in sports. Strains typically result from an eccentric muscle contraction and most frequently occur at the musculotendinous junction. Proximal hamstring rupture from the ischial tuberosity occurs acutely during high-speed activities such as sprinting, hurdling, and dancing. These injuries can result in substantial functional impairment, and surgical repair of proximal hamstring avulsions results in subjective highly satisfactory outcomes.

This video shows the gross anatomy of the deep gluteal space and the bony attachment of the proximal hamstring tendons on the ischial tuberosity and demonstrates open and endoscopic proximal hamstring tear repair. Nineteen patients (11 men and 8 women) with a mean age of 41.5 years (range, 17 to 73 years; standard deviation ± 13.9 years) and a proximal hamstring tear who underwent surgical repair (5 open surgery and 14 endoscopic surgery) are retrospectively reviewed. All the patients had acute pain after sports activity except for four of the patients, all of whom had a slow and insidious presentation of pain. Proximal hamstring tears were confirmed using MRI. Six of the patients had a complete three-tendon tear (semimembranosus tendon and conjoint biceps femoris–semitendinosus tendon), eight of the patients had a complete tear of the conjoint biceps femoris–semitendinosus tendon, and five of the patients had a complete tear of the semimembranosus tendon. All the patients underwent surgical repair with the use of suture anchors. One patient with simultaneous ischiofemoral impingement underwent resection of the lesser trochanter. The rehabilitation protocol involved use of a hip orthosis for 6 to 8 weeks postoperatively, allowing progressive weight-bearing and range of motion. Outcomes were assessed at a mean follow up of 12 months (range, 4 to 28 months) using the modified Harris hip score and return to play (for 14 of the patients with previous sports practice). The mean modified Harris hip score increased from 60.1 points preoperatively (range, 35 to 73 points; standard deviation ± 10.9 points) to 93.01 points at final follow up (range, 85 to 98 points; standard deviation ± 3.94 points). The mean return to sports activity was 5 months postoperatively (range, 4 to 7 months). The surgical repair of proximal hamstring tears is an effective treatment option, resulting in excellent outcomes, a high level of pain relief, and return to function.