Southern California Orthopedic Institute, Van Nuys, California, U.S.A..
Southern California Orthopedic Institute, Van Nuys, California, U.S.A.
Arthroscopy. 2021 Nov;37(11):3227-3228. doi: 10.1016/j.arthro.2021.09.010.
Proximal hamstring tears are common among athletes, especially in sports involving eccentric lengthening during forced hip flexion and knee extension, such as hurdles or water skiing. Tears are described by timing (acute [<1 month] or chronic) and severity (partial or complete). Complete tears are easily identified with magnetic resonance imaging; however, partial tears may be subtle and potentially missed. The spectrum of pathology associated with acute injuries ranges from minor strains to complete tears or avulsions. Acute tears commonly present as pain and bruising over the posterior thigh along with weakness with active knee flexion and often a sensation of instability of the lower extremity. Chronic injuries typically present with ischial pain associated with repetitive activities, and the spectrum includes chronic tendinopathies, ischial bursitis, partial tears, and nonoperatively treated complete tears. Nonoperative treatment is recommended in the setting of low-grade partial tears and insertional tendinosis. However, failure of nonoperative treatment of partial tears may benefit from surgical debridement and repair. Further, surgical repair of complete tears with retraction is usually recommended for active patients. Historically, surgical treatment has been limited to open surgical approaches, although endoscopic management of proximal hamstring tears and chronic ischial bursitis is an option. Our endoscopic technique employs the use of two anchors, double loaded with high-strength suture, and may support a faster recovery due to decreased surgical morbidity. It is important to note that some patients may not be candidates for this endoscopic repair as a result of several factors, including prior chronic and retracted tears, as well as those with altered regional tissue planes due to prior surgical repair.
股四头肌近端撕裂在运动员中很常见，尤其是在涉及髋关节强制屈曲和膝关节伸展的偏心伸展的运动中，如跨栏或滑水。撕裂按时间（急性[<1 个月]或慢性）和严重程度（部分或完全）来描述。磁共振成像（MRI）很容易识别完全撕裂；然而，部分撕裂可能很细微，容易被遗漏。与急性损伤相关的病理谱范围从轻微的拉伤到完全撕裂或撕脱。急性撕裂通常表现为大腿后侧疼痛和瘀伤，伴有主动膝关节屈曲时的无力，并且常常伴有下肢不稳定的感觉。慢性损伤通常表现为与重复活动相关的坐骨疼痛，其谱包括慢性腱病、坐骨滑囊炎、部分撕裂和未经手术治疗的完全撕裂。对于低级别部分撕裂和插入性腱病，建议采用非手术治疗。然而，对于部分撕裂的非手术治疗失败，可能会受益于手术清创和修复。此外，对于有回缩的完全撕裂，通常建议积极的患者进行手术修复。历史上，手术治疗仅限于开放性手术方法，尽管近端股四头肌撕裂和慢性坐骨滑囊炎的内镜治疗是一种选择。我们的内镜技术采用两个锚定物，双加载高强度缝线，由于手术发病率降低，可能支持更快的恢复。需要注意的是，由于多种因素，包括先前的慢性和回缩性撕裂，以及由于先前的手术修复导致局部组织平面改变，一些患者可能不适合这种内镜修复。
