1
|
Yetter TR, Halvorson RT, Wong SE, Harris JD, Allahabadi S. Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment. Curr Rev Musculoskelet Med 2024; 17:373-385. [PMID: 39009901 PMCID: PMC11335994 DOI: 10.1007/s12178-024-09911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. RECENT FINDINGS Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.
Collapse
|
2
|
Segal O, Benady A, Pickholz E, Ovadia JE, Druckmann I, Dadia S, Rath E, Albagli A, Efrima B. MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases. BMC Musculoskelet Disord 2023; 24:969. [PMID: 38102608 PMCID: PMC10722811 DOI: 10.1186/s12891-023-07074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. METHODS In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. RESULTS All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. CONCLUSION These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
Collapse
Affiliation(s)
- Ortal Segal
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliana Pickholz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
3
|
Ranzoni LV, Guberovich MA, Ejnisman L, Miyahara HS, Rath E, Gurgel HMDC, Jacomo AL. Proximal endoscopic repair of the hamstring tendons: a cadaveric anatomical study of posterior hip portals. J Hip Preserv Surg 2023; 10:75-79. [PMID: 37900891 PMCID: PMC10604049 DOI: 10.1093/jhps/hnad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 01/10/2023] [Indexed: 10/31/2023] Open
Abstract
Arthroscopy and endoscopic hip surgery have attracted increasing attention in the orthopedic field. In the case of arthroscopy, portals and their relationships with neurovascular bundle structures at risk are well established. However, studies on endoscopic portals used for the repair of hamstring tendon injuries are insufficient. Hamstring injuries are the most common muscle injury in sports medicine, and up to 12% can present as a tendon rupture. Endoscopic surgery is advantageous because it has a lower rate of bleeding and avoids excessive handling of the gluteal muscles. The objective of this study is to perform an anatomical evaluation of endoscopic portals for hamstring repair and measure their distance to neurovascular structures-mainly sciatic nerve and posterior femoral cutaneous nerve (PFCN). Fifteen hips from frozen and formalized cadavers were evaluated. Specimens that showed any modification in their anatomy were excluded. Portals were simulated using Steinmann pins, and anatomical dissection was performed. Distances from neurovascular structures were measured using a digital caliper. Four male cadaver hips (26%) and eleven female cadaver hips (74%) were included. Two dissected hips presented PFCN injury through the posterolateral portal- mean 20.28 mm (±8.14), and one through the distal accessory portal- 21.87 mm (±12.03). The injury rate for PFCN was 3/15 or 20%. None of the portals presented sciatic nerve injury. Conclusion: There is an imminent risk of nerve injury to the PFCN by performing the lateral portals for hamstring repair. To avoid this, we recommend starting the procedure through the most medial (posteromedial) portal, and the other portals must be performed under direct visualization.
Collapse
Affiliation(s)
- Lucas Verissimo Ranzoni
- Department of Pathophysiology, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
| | - Matheus Almeida Guberovich
- Department of Pathophysiology, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
| | - Leandro Ejnisman
- Orthopedics Department, Hospital Israelita Albert Einstein, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010, Brazil
| | - Helder Souza Miyahara
- Orthopedics Department, Hospital das Clínicas—FMUSP, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Ehud Rath
- Orthopedics Department, Tel Aviv University School of Medicine, Tel Aviv-Yafo 6997801, Israel
| | - Henrique Melo de Campos Gurgel
- Orthopedics Department, Hospital das Clínicas—FMUSP, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Alfredo Luiz Jacomo
- Department of Surgery, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
| |
Collapse
|
4
|
Lawton CD, Sullivan SW, Hancock KJ, Burger JA, Nawabi DH, Kelly BT, Ranawat AS, Nwachukwu BU. Achievement of the minimal clinically important difference following open proximal hamstring repair. J Hip Preserv Surg 2021; 8:348-353. [PMID: 35505799 PMCID: PMC9052411 DOI: 10.1093/jhps/hnab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/05/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
There is a paucity of literature on patient-reported outcome measures (PROMs) following proximal hamstring repair beyond return to play, patient satisfaction and pain improvement. The minimal clinically important difference (MCID) defines the minimum degree of quantifiable improvement that a patient can perceive, but the MCID and predictors of this measure have not been defined for this patient population. This study aimed to define the MCID and determine the efficacy of open proximal hamstring repair through achievement of MCID and identify characteristics predictive of achieving MCID. A retrospective cohort review of an institutional hip registry was conducted, analyzing the modified Harris Hip Score (mHHS) and International Hip Outcome Tool (iHOT-33). MCID was calculated using a distribution-based method. Demographic and clinical variables predictive of achieving MCID were analyzed using univariable and multivariate logistic regression analyses. Thirty-nine patients who underwent open proximal hamstring repair were included. The mean patient age was 48.5 ± 12.4 years, with a mean follow-up of 37.1 ± 28 months. The MCID was determined for each PROM (mHHS—11.8; iHOT-33—12.6). A high percentage of patients achieved MCID for both PROMs (mHHS—85.7%; iHOT-33—91.4%). Univariate logistical regression demonstrated increased age (P = 0.163), increased body mass index (BMI; P = 0.072), requirement for inpatient admission (P = 0.088) and pre-operative iHOT-33 (P = 0.104) trended towards clinically significant predictors of not achieving MCID. A high percentage of patients achieved MCID while age, BMI, inpatient admission and pre-operative iHOT-33 appear to influence the achievement of clinically significant outcome in patients undergoing open proximal hamstring repair.
Collapse
Affiliation(s)
- Cort D Lawton
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Spencer W Sullivan
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Kyle J Hancock
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Joost A Burger
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medical College, New York, NY 10021, USA
| | - Bryan T Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medical College, New York, NY 10021, USA
| | - Anil S Ranawat
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medical College, New York, NY 10021, USA
| | - Benedict U Nwachukwu
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medical College, New York, NY 10021, USA
| |
Collapse
|
5
|
Factor S, Khoury A, Atzmon R, Vidra M, Amar E, Rath E. Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes. J Hip Preserv Surg 2021; 7:721-727. [PMID: 34377515 PMCID: PMC8349587 DOI: 10.1093/jhps/hnab006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20-61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2-43 months). At a mean follow-up of 28 months (range 12-55 months), the average PHAT score was 73 (range 70-80). The mean subjective activity level percentage improved from 34 (range 20-50) pre-surgery to 81 (range 75-90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.
Collapse
Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Amal Khoury
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Ran Atzmon
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Matias Vidra
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Eyal Amar
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Ehud Rath
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| |
Collapse
|
6
|
Grasso M, O’Neill C, Constantinescu D, Moatshe G, Vap A. Reconstruction of Chronic Proximal Hamstring Tear: Description of a Surgical Technique. Arthrosc Tech 2021; 10:e1307-e1313. [PMID: 34141546 PMCID: PMC8185645 DOI: 10.1016/j.eats.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 02/03/2023] Open
Abstract
While proximal hamstring tears at the myotendinous junction are common sports-related injuries that are often successfully treated nonoperatively, complete avulsions from the origin on the ischial tuberosity are less common and better treated with surgical repair to prevent significant functional limitations and ongoing weakness. The diagnosis can be easily missed, leading patients to present several months after the initial injury. In addition, some patients decide on nonoperative management initially but later present requesting surgical intervention. The delayed cases are challenging due to often significant tendon retraction, making direct repair difficult if not impossible. Techniques using allograft and autograft reconstruction have been described for this clinical situation. This Technical Note describes the use of 2 Achilles tendon allografts fixed via 5 suture anchors to reconstruct a chronic complete avulsion injury of the proximal hamstring with >5-cm retraction.
Collapse
Affiliation(s)
- Mackenzie Grasso
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia,Address correspondence to Mackenzie Grasso, M.D., Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA.
| | - Conor O’Neill
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| | - David Constantinescu
- Department of Orthopaedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A
| | - Gilbert Moatshe
- Division of Orthopaedic Surgery, Oslo University Hospital,Norwegian School of Sports Science, Oslo Sport Trauma Research Center, Oslo, Norway
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| |
Collapse
|
7
|
Maldonado DR, Annin S, Lall AC, Krych AJ, Athey AG, Spinner RJ, Hartigan DE, Emblom BA, Ryan MK, Domb BG. Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter Study With Minimum 2-Year Follow-up. Am J Sports Med 2021; 49:721-728. [PMID: 33449797 DOI: 10.1177/0363546520981767] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The preponderance of literature on the repair of proximal hamstring tendon tears focuses on the acute phase (<4 weeks). As such, there is a paucity of data reporting on the outcomes of chronic proximal hamstring tears. PURPOSE To report minimum 2-year postoperative patient-reported outcome (PRO) scores, visual analog scale (VAS) for pain, and patient satisfaction from patients who underwent open or endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears. STUDY DESIGN Case series study; Level of evidence, 4. METHODS Between April 2002 and May 2017, prospectively collected data from 3 tertiary care institutions were retrospectively reviewed for patients who underwent open and endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears. Patients were included only if they had a chronic proximal hamstring tear (defined as ≥4 weeks from symptom onset to surgery). Patients were excluded if they had a tear treated <4 weeks after injury, underwent hamstring reconstruction, or claimed workers' compensation. Patients who reported minimum 2-year follow-up for VAS, patient satisfaction, and the following PROs had their outcomes analyzed: the modified Hip Harris Score, Non-arthritic Hip Score, iHOT-12 (International Hip Outcome Tool), and Hip Outcome Score-Sports Specific Subscale. RESULTS Fifty patients (34 females and 16 males) were included in this study. There were 19 endoscopic repairs and 31 open repairs. Within the cohort, 52.0% had a full-thickness tendon tear on magnetic resonance imaging, and 48.0% had a partial tear. Average follow-up time was 58.07 ± 37.27 months (mean ± SD; range, 24-220 months). The mean age and body mass index of the group were 46.13 ± 13 years and 25.43 ± 5.14. The average time from injury to surgery was 66.73 weeks (range, 5.14-215.14 weeks). Average postoperative PROs were as follows: modified Hip Harris Score, 91.94 ± 9.96; Non-arthritic Hip Score, 91.33 ± 9.99; iHOT-12, 87.17 ± 17.54; Hip Outcome Score-Sports Specific Subscale, 87.15 ± 18.10; and VAS, 1.16 ± 1.92. Patient satisfaction was 8.22 ± 1.20. CONCLUSION Patients who underwent open and endoscopic repairs for chronic partial- and full-thickness proximal hamstring tendon tears reported high PROs and satisfaction at a minimum 2-year follow-up with low rates of complications.
Collapse
Affiliation(s)
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander G Athey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David E Hartigan
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| |
Collapse
|
8
|
Bataillie F, Bataillie S, van Beek N, Corten K. Portal placement for endoscopic surgery in the deep gluteal area: a cadaveric study. J Hip Preserv Surg 2020; 7:147-152. [PMID: 32382442 PMCID: PMC7195941 DOI: 10.1093/jhps/hnaa008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/09/2020] [Indexed: 12/03/2022] Open
Abstract
Partial or complete avulsion of the insertion of the proximal hamstrings at the level of the ischial tuberosity is most often treated by open exploration and reinsertion. However, endoscopic reinsertion could be considered to minimize the soft tissue damage. In this study, we aimed to determine the most optimal location of four endoscopic portals that allow for a safe exploration of the proximal hamstring insertion site. The reference points for the portals run vertically through the center of the sciatic tuberosity and through a horizontal line which lies on the inferior edge of the tuberosity. The distance and relationship between the sciatic, the inferior gluteal and posterior femoral cutaneous nerves and the four proposed endoscopic portals was documented. Our results showed that it was best to start with the inferior portal followed by the medial and lateral portal. The inferior portal allowed for a clear visualization of the sciatic nerve and was along with the medial portal at a distance of >5 cm from any of the surrounding nerves. Care must be taken with the lateral portal, as the distance to the surrounding nerves varied between specimens. A fourth portal could be used as a viewing portal when necessary. Our study showed that the sequence and position of the proposed endoscopic portals provide a safe approach to the proximal part of the hamstrings and the ischial tuberosity. These findings can be helpful for endoscopic procedures to the ischium and the sciatic nerve in the gluteal region.
Collapse
Affiliation(s)
- F Bataillie
- Department of Orthopedic Surgery, AZ Hospital, Herentals, Belgium
| | - S Bataillie
- Department of Ophthalmology, UZLeuven, Leuven, Belgium
| | - N van Beek
- Department of Orthopedic Surgery, AZ Hospital, Herentals, Belgium
| | - K Corten
- Hip Unit, Orthopaedic Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| |
Collapse
|