Cotter Eric J, Kazi Omair, Vogel Michael J, Nho Shane J
Rush University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2025 Feb 11;5(1):26350254241291593. doi: 10.1177/26350254241291593. eCollection 2025 Jan-Feb.
Tearing of the proximal hamstring tendon is a common injury in athletes for which surgical repair is being increasingly utilized. The described techniques for endoscopic repair employ a simple or mattress suture configuration. We hypothesize that the incorporation of a running modified whipstitch may allow for increased suture purchase and sturdier tendon fixation.
Patients with partial tears, 2-tendon tears and >2 cm retraction, or 3-tendon tears refractory to conservative management are typically indicated for surgery.
In the prone position, 2 portals are established in the gluteal crease. Neurologic structures such as the posterior femoral cutaneous nerve and the sciatic nerve are visualized. The ischium is decorticated, and a triple-loaded suture anchor is placed in the ischial tuberosity. Using a tissue penetrator and a suture-passing device, a modified whipstitch suture configuration is constructed to secure the torn tendons.
Overall, following endoscopic surgical repair, most patients demonstrate improvement in functional outcomes metrics and achievement of patient acceptable symptom state in >70% of cases. Return-to-sport rate between 77.3% and 95% has been described in the literature.
DISCUSSION/CONCLUSION: Open repair utilizes a running suture configuration, whereas endoscopic repair has traditionally been performed with simple or mattress constructs. A modified whipstitch, performed endoscopically, may provide the durability of open repair with decreased rates of perioperative complications associated with endoscopic repair. Further work comparing suture techniques and postoperative outcomes should be investigated.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
腘绳肌近端肌腱撕裂是运动员常见的损伤，手术修复的应用越来越广泛。所描述的内镜修复技术采用简单或褥式缝合方式。我们假设采用连续改良锁边缝合法可能会增加缝线的抓持力并实现更牢固的肌腱固定。
部分撕裂、双肌腱撕裂且回缩>2 cm或三肌腱撕裂且保守治疗无效的患者通常适合手术。
患者俯卧位，在臀皱襞处建立两个通道。可视化股后皮神经和坐骨神经等神经结构。对坐骨进行去皮质处理，并在坐骨结节处放置一个三重负载缝线锚钉。使用组织穿刺器和缝线传递装置，构建改良锁边缝合法以固定撕裂的肌腱。
总体而言，内镜手术修复后，大多数患者的功能结局指标有所改善，超过70%的病例达到了患者可接受的症状状态。文献报道的重返运动率在77.3%至95%之间。
讨论/结论：开放修复采用连续缝合方式，而传统上内镜修复采用简单或褥式结构。在内镜下进行改良锁边缝合，可能会提供开放修复的耐久性，同时降低与内镜修复相关的围手术期并发症发生率。应进一步开展比较缝线技术和术后结局的研究。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本提交内容包含患者的豁免声明或其他书面批准形式以供发表。
