Hip Hamstring Tears: Hamstring Tendon Repair With Anchors

Hip Hamstring Tears: Hamstring Tendon Repair With Anchors

This cadaveric surgical video demonstrates a hamstring tendon repair with anchors for the treatment of a hamstring tear at the hip. Here, we see the back of a right hip. The outer side of the hip is at the right side of the screen and the back of the thigh is at the bottom of the screen, and the surgeon has marked out the location of the ischial tuberosity, the bony bump on the pelvis where the tendons from the hamstring muscles attach.

The surgeon begins by making an incision along the back of the thigh, which in this demonstration is made slightly larger than what is typically done in the operating room. The incision may be horizontal, like this one, or vertical. Next, the surgeon cuts through the underlying soft tissue, identifies the gluteus maximus muscle, and uses a retractor to move it to the side in order to access the top of the hamstrings.

Before continuing with the procedure, the surgeon finds the sciatic nerve, a thick nerve that lies underneath the hamstring muscles and needs to be located to ensure that it does not get damaged during the procedure. The surgeon will also check to make sure that there is no scar tissue formed around the nerve. Here is the top of the hamstrings separated from the hip, and the conjoint tendon, which attaches 2 of the 3 hamstring muscles to the ischial tuberosity, has completely torn off from the bone.

A retractor is placed on both sides of the ischial tuberosity and surgical instruments are used to remove remaining bits of soft tissue from the bone. In this demonstration, the surgeon marks out where the anchors will be placed and will complete a double-row repair technique. A drill guide is placed over the first anchor site and tapped in place, and drills are inserted into the guide to drill a hole into the bone.

Part of the drill guide is removed and a hard-body anchor is inserted into the drilled hole and tapped in place, with the same steps repeated for a second anchor. Both anchors are already threaded with 2 strands of thick, flat sutures. The surgeon uses a curved needle to pass each suture strand through the hamstring tendon and uses the sutures to pull the tendon close to the bone, then passes 1 suture strand from each anchor into another hard-body anchor.

The surgeon drills holes into the remaining 2 anchor placement sites. The anchor with the threaded sutures is then inserted into 1 of the drilled holes and tapped in place to tack down the hamstring tendon to the bone. The same steps are repeated to thread the remaining sutures into another anchor and insert the anchor into the bone.

Once the surgeon achieves final tension of the repair, the excess sutures are cut off. The surgeon will close the skin and soft tissue with additional sutures, and the hamstring tendon repair is complete.