Surgical Technique: Allograft Augmentation of Chronic Hamstring Repair

Abstract

Proximal hamstring avulsion injuries are more commonly being recognized and can cause significant disability for the active patient. Patients frequently experience a loss of leg control and difficulties decelerating the leg, making athletic activities difficult. Unfortunately, patients may present late due to either misdiagnosis or failed attempts at conservative treatment. Retraction and scarring of the hamstring tendons can limit the surgeon’s ability to repair the tendon to the ischial tuberosity without excessive tension. Use of an Achilles tendon allograft, can obviate the need for distal fractional lengthening or tenodesis and provides improved outcomes for activities of daily living and sports-related activities.

This chapter provides key history and exam findings to aid in diagnosis and describes the surgical procedure for allograft reconstruction for irreparable ruptures. Tendon fixation is described through use of either suture anchors or bone plug and interference screw depending on patient characteristics and intraoperative visualization. Postoperative protocols including hinged knee bracing are outlined. Most patients return to sport by 6 months although will improve for a year following the surgery. Posterior thigh numbness and superficial skin infection are the most common adverse events. Return to sports is inferior to acute repair, but return to activities of daily living is comparable to acute repairs with universally high satisfaction rates after allograft reconstruction.