Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair

Wilson, Thomas J.; Spinner, Robert J.; Mohan, Rohith; Gibbs, Christopher M.; Krych, Aaron J.

doi:10.1177/2325967117713685

Cited by 58 publications

(42 citation statements)

References 16 publications

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“…Injury to the PFC nerve, including its perineal branches, has been reported to contribute to pain with sitting (Dellon, ). Likewise, proximal hamstring avulsion injuries have been known to entail injury to the sciatic nerve, presenting with symptoms below the knee (Wilson et al, ). Injury or entrapment of this nerve during or following surgical intervention could also in principle lead to adverse outcomes such as perineal pain.…”

Section: Discussionmentioning

confidence: 99%

The anatomy of the perineal branch of the sciatic nerve

et al. 2018

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A "perineal" branch of the sciatic nerve has been visualized during surgery, but there is currently no description of this nerve branch in the literature. Our study investigates the presence and frequency of occurrence of perineal innervation by the sciatic nerve and characterizes its anatomy in the posterior thigh. Fifteen cadavers were obtained for dissection. Descriptive results were recorded and analyzed statistically. Twenty-one sciatic nerves were adequately anatomically preserved. Six sciatic nerves contained a perineal branch. Five sciatic nerves had a branch contributing to the perineal branch of the posterior femoral cutaneous (PFC) nerve. In specimens with adequate anatomical preservation, the perineal branch of the sciatic nerve passed posterior to the ischial tuberosity in three specimens and posterior to the conjoint tendon of the long head of biceps femoris and semitendinosus muscles (conjoint tendon) in one. In specimens in which the perineal branch of the PFC nerve received a contribution from the sciatic nerve, the branch passed posterior to the sacrotuberous ligament in one case and posterior to the conjoint tendon in three. Unilateral nerve anatomy was found to be a poor predictor of contralateral anatomy (Cohen's kappa = 0.06). Our study demonstrates for the first time the presence and frequency of occurrence of the perineal branch of the sciatic nerve and a sciatic contribution to the perineal branch of the PFC nerve. Clinicians should be cognizant of this nerve and its varying anatomy so their practice is better informed. Clin. Anat. 31:357-363, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

The anatomy of the perineal branch of the sciatic nerve

et al. 2018

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“…The short head of the BF is innervated by the peroneal division of the sciatic nerve. 10 Anatomically, the relationship between the hamstrings and the sciatic nerve is very important. Approximately 1.2 ± 0.2 cm separate the nerve from the hamstring origin at the ischial tuberosity.…”

Section: Relevant Anatomymentioning

confidence: 99%

“…In a series of 162 patients with a partial or complete avulsion of the hamstring muscle group, 45 patients (27.8%) had neurological symptoms in the distribution of the sciatic nerve; 8 patients (4.9%) had motor deficits, 11 (6.8%) sensory deficits and 36 (22.2%) neuropathic pain. 10 A careful neurological evaluation should be performed to assess for sciatic nerve irritation, including posterior thigh sensation and distal motor and sensory function of the tibial and peroneal nerves. 24…”

Section: Clinical Evaluationmentioning

confidence: 99%

Proximal hamstring tendon avulsion: state of the art

et al. 2021

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Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.

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“…Studies have shown more difficult exposure as well as more sciatic nerve neurolyses were performed in surgically treated chronic tears. The intimate relationship of the sciatic nerve and hamstring attachment at the ischial tuberosity makes it vulnerable to injury both at the time of hamstring avulsion and at time of operative repair [15]. Careful dissection, identifying, and protecting the sciatic nerve as well as acute repair help reduce the risk of iatrogenic injury [8].…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct

Sanderson

Stumetz

Jazayeri

2020

Case Reports in Orthopedics

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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.

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Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair

Cited by 58 publications

References 16 publications

The anatomy of the perineal branch of the sciatic nerve

The anatomy of the perineal branch of the sciatic nerve

Proximal hamstring tendon avulsion: state of the art

Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct

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