Proximal hamstring repair: an overview of anatomy, indications, and techniques

Abstract

Purpose

This article details the surgical repair of proximal hamstring tears, anatomical landmarks, and specific indications for various approaches, including endoscopic, open, and “scopen” (endoscopic-to-open).

Objectives

The objectives of this article are to (1) evaluate key anatomical landmarks during proximal hamstring repair to ensure safe and efficient proceedings, (2) provide guidance on the specific indications for various approaches, including endoscopic, open, and “scopen” repair of proximal hamstring tears, and (3) highlight technical pearls specifically relating to these approaches.

Surgical technique

An endoscopic approach utilizes a viewing and working portal, also along the gluteal crease, for accurate visualization of these structures. An open approach utilizes an incision along the gluteal crease for exposure to identify the tear, surrounding nerves, and ischial tuberosity footprint. The “scopen” approach combines both techniques, beginning with portals creation for endoscopic lysis of adhesions, sciatic nerve protection, and tear identification, followed by a mini-open extension of the incision between the portals to create sufficient working space to perform the repair.

Conclusions

Proximal hamstring injuries can vary widely in presentation, ranging from acute to chronic injuries with varying degrees of tendon involvement, retraction, and scar formation. The open, endoscopic, and “scopen” approaches are all viable surgical options in addressing proximal hamstring tears. A detailed understanding of anatomical landmarks and various approaches with their associated indications and techniques can further optimize patient outcomes.