The Endoscopic-to-Open Proximal Hamstring Repair Technique for Chronic, High-Grade Tears.

Although open repair has been the historical standard for surgical treatment of proximal hamstring tears, enthusiasm for an endoscopic approach has grown because of its minimally invasive nature and advantages of improved visualization of the tendon footprint and adjacent neurovascular structures. Despite this, larger or more retracted tendon tears may still prove challenging to appropriately treat entirely endoscopically. The endoscopic-to-open technique aims to address this issue. Patients are positioned prone with the surgical limb placed on a padded Mayo stand with the knee flexed. Direct posterior and posterolateral portals are created in the gluteal fold for the endoscopic portion of the case, including ischial bursectomy, preparation of the tendon footprint, and anchor placement, before the interposing skin incision is created for the open portion of the case. The hamstring tendon is then accessed, mobilized, and repaired with a docking technique. Final arthroscopic visualization is subsequently performed to confirm adequate protection of critical neurovascular structures. An endoscopic-to-open treatment approach may provide surgeons with the visualization benefits of an endoscopic approach during preparation of the ischial tuberosity while also providing the access and maneuverability required for tendon mobilization and repair tensioning conferred by an open approach.