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Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct.

ABSTRACT: 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.

SUBMITTER: Sanderson B

PROVIDER: S-EPMC7422414 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct.

Sanderson Brent B Stumetz Kyle K Jazayeri Reza R

Case reports in orthopedics 20200802

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 o ...[more]

PMID: 32832177

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Project description:BackgroundKnot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates.PurposeTo compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity.Study designRandomized controlled trial; Level of evidence, 1.MethodsA total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial).ResultsOverall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03).ConclusionBoth techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique.RegistrationNCT03982108 (ClinicalTrials.gov identifier).

Dataset Information

Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct.

Publications

Repair of Proximal Hamstring Tear Utilizing a Suture Bridge Knotless Construct.

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