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Surgical Technique: Open Proximal Hamstring Repair

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Hip Arthroscopy and Hip Joint Preservation Surgery

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Abstract

The proximal hamstring is a common location for athletic injuries. A complete, three-tendon (semitendinosus, semimembranosus, and long head of the biceps femoris) tear may occur in sports that involve eccentric contractions of the hamstrings with rapid hip flexion and knee extension. Surgical treatment of multi-tendon tears with retraction in active patients has demonstrated significantly better subjective and objective outcomes at short- and mid-term follow-up. A safe surgical approach is performed via prone positioning, transverse or longitudinal skin incision at the gluteal fold, avoidance of the posterior femoral cutaneous and sciatic nerves, exposure of the ischial tuberosity and proximal hamstring anatomic footprint, secure anchor fixation, appropriate hemostasis, and meticulous closure. Chronic repair often requires extensive lysis of adhesions, sciatic neurolysis, tendon mobilization, and possibly allograft augmentation. Postoperative rehabilitation should initially avoid undue stress on the repair from hip flexion and knee extension to allow adequate healing before advancing mobilization and strength training.

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References

  1. Engebretsen A, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players. Am J Sports Med. 2010;38(6):1147–53.

    Article  Google Scholar 

  2. Arnason A, Sigurdsson S, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004;32(Suppl):5S–16.

    Article  Google Scholar 

  3. Harris JD, Griesser MJ, Best TM, Ellis TJ. Treatment of proximal hamstring ruptures – a systematic review. Int J Sports Med. 2011;32(7):490–5.

    Article  CAS  Google Scholar 

  4. Witvrouw E, Danneels L, Asselman P, D’Have T, Cambier D. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study. Am J Sports Med. 2003;31:41–6.

    Article  Google Scholar 

  5. Klingele K, Sallay P. Surgical repair of complete proximal hamstring tendon ruptures. Am J Sports Med. 2002;30:742–7.

    Article  Google Scholar 

  6. Wood D, Packham I, Trikha S, Linklater J. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am. 2008;90:2365–74.

    Article  Google Scholar 

  7. Shambaugh BC, Olsen JR, Lacerte E, Kellum E, Miller SL. A comparison of nonoperative and operative treatment of complete proximal hamstring ruptures. Orthop J Sports Med. 2017;5(11):232596711773855. https://doi.org/10.1177/2325967117738551.

    Article  Google Scholar 

  8. Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med. 1996;24(2):130–6.

    Article  CAS  Google Scholar 

  9. Chahal J, Bush-Joseph CA, Chow A, Zelazny A, Mather RC, Lin E, et al. Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal? Am J Sports Med. 2012;40:2325–30.

    Article  Google Scholar 

  10. Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med. 2008;36(1):104–9.

    Article  Google Scholar 

  11. Gidwani S, Bircher M. Avulsion injuries of the hamstring origin – a series of 12 patients and management algorithm. Ann R Coll Surg Engl. 2007;89:394–9.

    Article  Google Scholar 

  12. Konan S, Haddad F. Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. Int Orthop. 2010;34:119–23.

    Article  Google Scholar 

  13. Miller SL, Gill J, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am. 2007;89(1):44–8.

    Article  Google Scholar 

  14. Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med. 2008;36:1110–5.

    Article  Google Scholar 

  15. Folsom G, Larson C. Surgical treatment of acute versus chronic complete proximal hamstring ruptures- results of a new allograft technique for chronic reconstructions. Am J Sports Med. 2007;36:104–9.

    Article  Google Scholar 

  16. Piposar JR, Vinod AV, Olsen JR, Lacerte E, Miller SL. High-grade partial and retracted (<2 cm) proximal hamstring ruptures: nonsurgical treatment revisited. Orthop J Sports Med. 2017;5(2):232596711769250. https://doi.org/10.1177/2325967117692507.

    Article  Google Scholar 

  17. Bodendorfer BM, Curley AJ, Kotler JA, et al. Outcomes after operative and nonoperative treatment of proximal hamstring avulsions: a systematic review and meta-analysis. Am J Sports Med. 2018;46(11):2798–808. https://doi.org/10.1177/0363546517732526.

    Article  PubMed  Google Scholar 

  18. Subbu R, Benjamin-Laing H, Haddad F. Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med. 2015;43(2):385–91. https://doi.org/10.1177/0363546514557938.

    Article  PubMed  Google Scholar 

  19. Blakeney WG, Zilko SR, Edmonston SJ, Schupp NE, Annear PT. A prospective evaluation of proximal hamstring tendon avulsions: improved functional outcomes following surgical repair. Knee Surg Sports Traumatol Arthrosc. 2017;25(6):1943–50. https://doi.org/10.1007/s00167-017-4475-0.

    Article  PubMed  Google Scholar 

  20. Wilson TJ, Spinner RJ, Mohan R, Gibbs CM, Krych AJ. Sciatic nerve injury after proximal hamstring avulsion and repair. Orthop J Sports Med. 2017;5(7):232596711771368. https://doi.org/10.1177/2325967117713685.

    Article  Google Scholar 

  21. Wilson TJ, Howe BM, Spinner RJ, Krych AJ. Imaging characteristics predict operative difficulty mobilizing the sciatic nerve for proximal hamstring repair. Neurosurgery. 2018;83(5):931–9. https://doi.org/10.1093/neuros/nyx553.

    Article  PubMed  Google Scholar 

  22. Philippon MJ, Ferro FP, Campbell KJ, et al. A qualitative and quantitative analysis of the attachment sites of the proximal hamstrings. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2554–61. https://doi.org/10.1007/s00167-014-3074-6.

    Article  PubMed  Google Scholar 

  23. Feucht MJ, Plath JE, Seppel G, Hinterwimmer S, Imhoff AB, Brucker PU. Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2576–82. https://doi.org/10.1007/s00167-014-3124-0.

    Article  PubMed  Google Scholar 

  24. Moatshe G, Chahla J, Vap AR, et al. Repair of proximal hamstring tears: a surgical technique. Arthrosc Tech. 2017;6(2):e311–7. https://doi.org/10.1016/j.eats.2016.10.004.

    Article  PubMed  PubMed Central  Google Scholar 

  25. van der Made AD, Reurink G, Gouttebarge V, Tol JL, Kerkhoffs GM. Outcome after surgical repair of proximal hamstring avulsions: a systematic review. Am J Sports Med. 2015;43(11):2841–51. https://doi.org/10.1177/0363546514555327.

    Article  PubMed  Google Scholar 

  26. Kurowicki et al. Short term outcomes following endoscopic hamstring repair. Arthroscopy. 2020;36(5):1301–7.

    Article  Google Scholar 

  27. Maldonado et al. Outcomes of open and endoscopic repair of chronic partial- and full-thickness proximal hamstring tendon tears. AJSM. 2021;49(3):721–8.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Kevin C. Parvaresh

  2. Houston Methodist Center for Orthopaedics & Sports Medicine, Houston, TX, USA

    Joshua D. Harris

  3. Midwest Orthopaedics at Rush, Hip Preservation Center, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  4. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA

    Charles A. Bush-Joseph

Authors
  1. Kevin C. Parvaresh
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  2. Joshua D. Harris
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  3. Shane J. Nho
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  4. Charles A. Bush-Joseph
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Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Houston Methodist Center for Orthopaedics and Sports Medicine, Houston, TX, USA

    Joshua D. Harris

  2. Rush University Medical Center, Chicago, IL, USA

    Joshua D. Harris

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Parvaresh, K.C., Harris, J.D., Nho, S.J., Bush-Joseph, C.A. (2021). Surgical Technique: Open Proximal Hamstring Repair. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_78-2

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_78-2

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7321-3

  • Online ISBN: 978-1-4614-7321-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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Chapter history

  1. Latest

    Surgical Technique: Open Proximal Hamstring Repair
    Published:
    30 October 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_78-2

  2. Original

    Surgical Technique: Open Proximal Hamstring Repair
    Published:
    25 February 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_78-1

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