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First published online August 14, 2019

Portal Placement and Biomechanical Performance of Endoscopic Proximal Hamstring Repair

Michael K. Ryan, MD, David P. Beason, MS [email protected], Glenn S. Fleisig, PhD, and Benton A. Emblom, MDView all authors and affiliations
Volume 47, Issue 12
https://doi.org/10.1177/0363546519866453

Abstract

Background:

Proximal hamstring tendon avulsions are debilitating and commonly cause pain, weakness, and functional limitations. Open surgical repair has been the standard, but improved endoscopic techniques have enabled proximal hamstring fixation with decreased risk of infection and numbness, without the morbidity of a large incision.

Purpose/Hypothesis:

The purpose was to (1) describe pertinent anatomy surrounding the proximal hamstring origin in relation to 4 endoscopic portal sites and (2) test for biomechanical differences between open and endoscopic repair. It was hypothesized that (1) endoscopic proximal hamstring repair is efficacious with respect to commonly used portals and (2) there is no biomechanical difference between open and endoscopic techniques.

Study Design:

Descriptive and controlled laboratory study.

Methods:

Proximal hamstring ruptures were simulated endoscopically in 10 fresh-frozen human cadaveric pelvis specimens. Endoscopic repair was then completed on 1 limb from each specimen through 4 portals. After repair, each specimen was dissected in layers and measurements from portal tracts to pertinent anatomy were obtained. Open repair was performed on all contralateral limbs, followed by cyclical biomechanical tensile testing to failure of both the open and endoscopically repaired hamstring tendons to assess failure load and local tissue strain.

Results:

On average, no portal tract was closer than 2.0 cm to the sciatic nerve or inferior gluteal neurovascular bundle. Anatomic landmarks were identified that could improve the reproducibility and safety of the procedure. Biomechanical testing revealed no differences between the open and endoscopic repair techniques for any measured parameter.

Conclusion:

This study supports the safety and efficacy of endoscopic proximal hamstring repair through anatomic and biomechanical analyses and helps establish reproducible and recognizable landmarks that define a safe working zone.

Clinical Relevance:

This study maps the anatomic landscape of the proximal hamstring as encountered endoscopically and demonstrates equivalent biomechanical strength of endoscopic proximal hamstring repair, supporting this technique’s safety and efficacy.

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Supplementary Material

Supplementary Material

5-in-5 Podcast

Five articles from the October 2019 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Portal Placement and Biomechanical Performance of Endoscopic Proximal Hamstring Repair," "Nonabsorbable Suture Knot on the Tendon Affects Rotator Cuff Healing: A Comparative Study of the Knots on Tendon and Bone in a Rat Model of Rotator Cuff Tear," "Increased Chondrocytic Gene Expression Is Associated With Improved Repair Tissue Quality and Graft Survival in Patients After Autologous Chondrocyte Implantation," "The Number of Injury Events Associated With the Critical Size of Bipolar Bone Defects in Rugby Players With Traumatic Anterior Shoulder Instability," and "Association Between Running Shoe Characteristics and Lower Extremity Injuries in United States Military Academy Cadets."

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Information

Published In

Volume 47, Issue 12
Pages: 2985 - 2992
Article first published online: August 14, 2019
Issue published: October 2019

Keywords

  1. proximal hamstring rupture
  2. endoscopic proximal hamstring repair
  3. biomechanical proximal hamstring

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© 2019 The Author(s).
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History

Published online: August 14, 2019
Issue published: October 2019
PubMed: 31412206

Authors

Affiliations

Michael K. Ryan, MD
American Sports Medicine Institute, Birmingham, Alabama, USA
Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
View all articles by this author
David P. Beason, MS‡
American Sports Medicine Institute, Birmingham, Alabama, USA
[email protected]
View all articles by this author
Glenn S. Fleisig, PhD
American Sports Medicine Institute, Birmingham, Alabama, USA
View all articles by this author
Benton A. Emblom, MD
American Sports Medicine Institute, Birmingham, Alabama, USA
Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
View all articles by this author
Investigation performed at American Sports Medicine Institute, Birmingham, Alabama, USA

Notes

‡
David P. Beason, MS, American Sports Medicine Institute, 833 St Vincent’s Drive, Suite 205, Birmingham, AL 35205, USA (email: [email protected]).

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