Endoscopic Hamstring Repair

What is Endoscopic Proximal Hamstring Repair?

Endoscopic proximal hamstring repair is a minimally invasive surgery performed using an endoscope - a thin, long, flexible tube with a camera and light attached to it - that enables your surgeon to view inside the body and carry out a proximal hamstring repair through very small incisions and special instruments.

The hamstrings are a group of three thigh muscles that extend from the pelvis to the knee joint. These muscles help in extending your leg and bending your knee. Therefore, any injury or damage to the hamstring muscle group affects both hip and knee movements. The hamstring muscles attach, via a tendon, to the ischial tuberosity (the bones you sit on, deep to your buttock muscles). This tendon is called the proximal hamstring tendon. A proximal (high) hamstring tear occurs when one or more of the muscles is torn from the ischial tuberosity, the attachment site.

Indications for Endoscopic Proximal Hamstring Repair

Your surgeon may recommend endoscopic proximal hamstring repair for small hamstring tears without significant retraction or when conservative treatment modalities have failed to provide desired results after a proximal hamstring tear.

Hamstring injuries that occur at the very top of the thigh are referred to as proximal hamstring tears. The reason for their special recognition is that certain proximal hamstring tears may necessitate surgical repair, whereas most distal hamstring injuries can be treated with conservative measures. Proximal hamstring tendon injuries are common among active and athletic populations and range from proximal tendinopathy to partial tears to complete avulsions.

Preparation for Endoscopic Proximal Hamstring Repair

In general, preparation for endoscopic proximal hamstring repair will involve the following steps:

• A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
• Diagnostic tests such as blood work and imaging such as X-ray and MRI may also be performed to determine the extent and type of injury and plan the procedure accordingly.
• Disclosing information about any allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking medications such as blood thinners and anti-inflammatories, or other supplements for a week or two.
• You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Endoscopic Proximal Hamstring Repair

In general, the procedure for endoscopic proximal hamstring repair will involve the following steps:

• The procedure is performed under general and/or regional anesthesia with you lying in a prone (face-down) position.
• The skin around the bottom of your buttocks is sterilized with an antiseptic solution and 2 to 3 small incisions or portals are made.
• Under fluoroscopic guidance (live X-ray images), an endoscope is inserted through one of the incisions and the high-definition video camera at its end displays the images of the inside of the body onto an external monitor that is connected to the endoscope, helping the doctor see the injured proximal hamstring area.
• Special miniature instruments are passed through other incisions, and the torn proximal hamstring tendon is pulled back into place and secured to the bone (the attachment site) with the help of suture anchors.
• Your doctor examines the integrity of your muscles with the bone, and after confirming satisfactory repair, the scope and the instruments are withdrawn, and the incisions are closed with stitches or surgical tape.

Postoperative Care and Recovery

In general, postoperative care and recovery after endoscopic proximal hamstring repair will involve the following steps:

• Postoperative recovery for endoscopic surgery usually requires 6 weeks of restricted weight bearing to protect the repair. You will be placed on assistive devices such as crutches and a brace to promote healing and recovery.
• You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots or deep vein thrombosis (DVT) in the leg.
• You may experience pain, swelling, and discomfort in the treatment area. Pain and anti-inflammatory medications are provided as needed to address these.
• Antibiotics may also be prescribed to address the risk of surgery-related infection.
• You may also apply ice packs on the buttock area to help reduce swelling and pain.
• Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities and lifting heavy weights for at least a couple of months. A gradual increase in activities is recommended.
• An individualized physical therapy regimen with gentle stretching exercises will be designed to improve the range of motion and flexibility.
• Most patients should be able to return to their normal activities in a couple of months, but with certain activity restrictions. Return to sports may take 6 months or longer.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Endoscopic Proximal Hamstring Repair

Some of the benefits of endoscopic proximal hamstring repair over traditional open hamstring repair include:

• Shorter hospital stay and quicker recovery
• Smaller incisions
• Smaller, less noticeable scars
• Less pain and blood loss
• Minimal damage to muscles and soft tissue
• Lower risk of complications

Risks and Complications

Endoscopic proximal hamstring repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Thromboembolism or blood clots
• Adverse reactions to anesthesia