Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct

Abstract

Proximal hamstring tendon injuries occur frequently in the athletic population resulting in varying degrees of functional disability depending on severity of injury. The purpose of our case vignette is to describe a surgical technique and clinical outcome for open proximal hamstring tendon repair with a confirmed biomechanically sound construct. We also describe and summarize the current literature recommendations for proximal hamstring injuries. We present a case and surgical technique report on a 27-year-old male who suffered a proximal hamstring tendon rupture. Utilizing a double row all-knotless suture bridge construct with a total of four anchors and six suture limbs allowed for anatomic footprint coverage and strength. Two years of clinical follow-up was obtained evaluating hip and knee range of motion, strength, and functional ability. Our patient underwent uncomplicated open surgical repair and returned to all activity at four months following surgery. Range of motion and strength returned to preoperative levels at the four-month postoperative mark. The use of a reproducible double row all-knotless suture bridge technique provided adequate strength and stability in the setting of a proximal hamstring tendon rupture. Open and endoscopic surgical techniques performed acutely both show positive postoperative subjective outcomes as well as a high likelihood of returning to sport. Controversy remains present in regard to the repair technique as well as postoperative bracing and physical therapy recommendations.

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

“…Lastly, compared to previous knotless techniques, the independent mattress configuration of our technique may improve pullout strength by eliminating interconnected sutures between anchors. 11 , 16 …”

Endoscopic Ischial Tuberosity Osteophyte Resection for Treatment of Ischiofemoral Impingement: A Case Report

“…The semimembranosus muscle adds stability to the knee and functions to flex and medially rotate the leg at the knee, as well as extending, adducting, and medially rotating the thigh at the hip. 23 The widely accepted view regarding the surgical indications for traumatic hamstring tendon femoral avulsion injury is that 2 tendons are avulsed and the retraction is >2 cm or 3 tendons are avulsed. 24 Although only 2 tendons (semitendinosus and long-head tendon of the biceps femoris) were involved in our case, suture anchor insertion reconstruction was performed to avoid iatrogenic hamstring tendon insufficiency.…”

Repair of avulsion fracture of the anterior superior iliac spine by knotless suture bridge: Surgical technique and a review of 5 cases

“…To avoid the above risks, ASIS avulsion fracture is repaired with double row and three anchors and triangular gather knotless suture bridge technique. Knotless suture bridge technique is often used to repair rotator cuff injury [10,[12][13][14] , and has been gradually used to repair tendinous structures such as Achilles tendon [15] , quadriceps tendon [16] and hamstring muscles [17] in recent years, showing good repair outcomes. In this study, short-term follow-up after surgery also showed the excellent performance of this technique.…”