Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct

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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Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118755116 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711875511 ◽

Cited By ~ 7

Author(s):

Harry M. Lightsey ◽

David E. Kantrowitz ◽

Hasani W. Swindell ◽

David P. Trofa ◽

Christopher S. Ahmad ◽

...

Keyword(s):

United States ◽

Range Of Motion ◽

Tendon Repair ◽

Hamstring Tendon ◽

Search Term ◽

Postoperative Rehabilitation ◽

Professional Literature ◽

Rehabilitation Protocol ◽

Rehabilitation Protocols ◽

Proximal Hamstring

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training. Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.

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Endoscopic Repair of Proximal Hamstring Tear With Double-Row Suture Bridge Construct

Arthroscopy Techniques ◽

10.1016/j.eats.2019.02.013 ◽

2019 ◽

Vol 8 (7) ◽

pp. e675-e678 ◽

Cited By ~ 4

Author(s):

Nabil Mehta ◽

Thomas Alter ◽

Edward C. Beck ◽

Jourdan M. Cancienne ◽

Leah R. Bressler ◽

...

Keyword(s):

Endoscopic Repair ◽

Double Row ◽

Suture Bridge ◽

Proximal Hamstring

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Restoring Full Squat Range of Motion by Applying OMT to Superior Innominate Shear: A Case Report

The AAO Journal ◽

10.53702/2375-5717-29.2.7 ◽

2019 ◽

Vol 29 (2) ◽

pp. 7-12

Author(s):

Drew D. Lewis ◽

Jonathan Pickos

Keyword(s):

Case Report ◽

Range Of Motion ◽

Low Back ◽

Present Case Report ◽

High School Athlete ◽

Hamstring Strain ◽

Hamstring Injuries ◽

Male High School ◽

Therapy Sessions ◽

Proximal Hamstring

Abstract Hamstring injuries in sports are common and often require rest or more active rehabilitative efforts before returning to sport-specific participation. This case report provides a potential framework of osteopathic manipulative treatment (OMT) for an acute traumatic superior innominate shear where traditional medical treatment, including physical therapy sessions, failed to provide significant and/or complete resolution. In the present case report, a 17-year-old male high-school athlete presented with hamstring strain and proximal hamstring and low back pain, following a hurdle injury with fall on extended knee. He was found to have significant somatic dysfunctions related to his condition. An OMT approach was utilized to provide relief, restore his full squat range of motion, and ultimately return to non-restricted football and basketball participation.

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Surgical Repair of Complete Proximal Hamstring Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/03635465020300051901 ◽

2002 ◽

Vol 30 (5) ◽

pp. 742-747 ◽

Cited By ~ 129

Author(s):

Kevin E. Klingele ◽

Peter I. Sallay

Keyword(s):

Tendon Rupture ◽

Surgical Repair ◽

Return To Sport ◽

Hamstring Tendon ◽

Nonoperative Treatment ◽

Activity Level ◽

Rare Injury ◽

Muscle Testing ◽

Postoperative Physical Therapy ◽

Proximal Hamstring

Background: Complete proximal hamstring tendon rupture is a rare injury associated with significant functional loss. Nonoperative treatment has proven inadequate in returning patients to their previous activity level. Purpose: We wanted to describe the outcome of primary surgical repair of the proximal hamstring tendon avulsion. Study Design: Retrospective cohort study. Methods: Between 1994 and 1999, 11 patients (4 women and 7 men) with an average age of 41.5 years (range, 21 to 51) had a diagnosis of complete proximal hamstring tendon rupture based on mechanism of injury, physical examination, and radiographic assessment. All underwent a single operation followed by standard postoperative physical therapy. At the latest follow-up (average, 34 months), patients completed a questionnaire regarding such outcome parameters as pain, function, leg control, stiffness, return to activity, and overall satisfaction. Results: Isokinetic muscle testing revealed an overall average of 91% return of hamstring muscle strength. Ten of 11 patients were satisfied with the result, and 7 of 9 athletically active patients were able to return to sport an average of 6 months (range, 3 to 10) after surgery. No difference between early and late repairs was identified in regard to functional outcome or return to sport. Conclusions: Satisfactory results can be achieved with both early and late hamstring tendon repairs in a majority of cases with surgical repair.

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Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

Journal of Wrist Surgery ◽

10.1055/s-0040-1721452 ◽

2020 ◽

Author(s):

Tomoyuki Kato ◽

Taku Suzuki ◽

Makoto Kameyama ◽

Masato Okazaki ◽

Yasushi Morisawa ◽

...

Keyword(s):

Range Of Motion ◽

Tendon Rupture ◽

Extensor Tendon ◽

Distal Radioulnar Joint ◽

Wrist Flexion ◽

Level Of Evidence ◽

Radioulnar Joint ◽

The Mean ◽

Therapeutic Study ◽

Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

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Reconstruction of Chronic Proximal Hamstring Tear: Description of a Surgical Technique

Arthroscopy Techniques ◽

10.1016/j.eats.2021.01.028 ◽

2021 ◽

Author(s):

Mackenzie Grasso ◽

Conor O’Neill ◽

David Constantinescu ◽

Gilbert Moatshe ◽

Alexander Vap

Keyword(s):

Surgical Technique ◽

Proximal Hamstring

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Fixationssysteme und Techniken zur arthroskopischen Rotatorenmanschettenrekonstruktion

Arthroskopie ◽

10.1007/s00142-021-00440-3 ◽

2021 ◽

Author(s):

Paul Borbas ◽

Karl Wieser ◽

Florian Grubhofer

Keyword(s):

Double Row ◽

Single Row ◽

Suture Bridge

ZusammenfassungArthroskopische Rotatorenmanschettenrekonstruktionen wurden initial mit einer einreihigen („single row“) Technik beschrieben. Im Rahmen technischer Weiterentwicklungen der arthroskopischen Chirurgie wurden diverse Techniken zur zweireihigen („double row“), transossären und transossär-äquivalenten Sehnenfixation entwickelt, nicht zuletzt durch eine zunehmende Verbreitung knotenloser Anker. Die klinischen Ergebnisse zeigen keine relevanten Unterschiede zwischen den jeweiligen Techniken. Biomechanisch sind zweireihige Rekonstruktionen jedoch durch Vergrößerung der Kontaktfläche an der Insertionsstelle und der erreichten Stabilität überlegen, insbesondere mit medial geknoteten Fäden, welche in eine laterale Reihe als sog. Suture-Bridge abgespannt werden. Klassischerweise wurden Schraubanker aus Metall für eine arthroskopische Sehnenfixierung verwendet. Im Laufe der letzten Jahre wurde das Anker-Portfolio jedoch durch moderne bioresorbierbare und nichtresorbierbare (PEEK) Schraub- und Einschlaganker sowie auch um reine Fadenanker (All-suture) erweitert. Ein allgemeingültiger Goldstandard für die Ankerverwendung existiert bis dato nicht, wobei die meisten gängigen Anker – zumindest bei guter Knochenqualität – ausreichende Stabilität gewährleisten. Beim Nahtmaterial kam es ebenso zu relevanten Weiterentwicklungen, sodass dem Versagen der Nähte heutzutage weniger Bedeutung zukommt. Das Aufkommen von bandartigem Nahtmaterial (Tapes) konnte in diversen biomechanischen Studien seine Überlegenheit nachweisen, jedoch ist bei geknoteten Techniken mit Tapes aufgrund des womöglich negativen Einflusses durch größere Knoten Vorsicht geboten. Nicht zuletzt ist die mediale Stichposition möglichst nahe des Rotatorenkabels von großer Bedeutung, da der häufigste Versagensmechanismus einer Rotatorenmanschettenrekonstruktion mit modernem Naht- und Ankermaterial weiterhin ein Hindurchschneiden der Fäden durch das vorgeschädigte Sehnengewebe ist.

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