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. In the acute setting, patients frequently experience a loss of leg control and difficulties decelerating the leg, making athletic activities challenging. Unfortunately, many patients present for potential surgical intervention chronically due to either misdiagnosis or failed attempts at conservative treatment. Retraction and scarring of the hamstring tendons create a challenging surgical problem that can limit the surgeon’s ability to re-approximate and successfully repair the tendon to the ischial tuberosity without excessive tension. In these situations, reconstruction with 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. Despite the limited patient outcomes data on this topic, the literature has demonstrated improved outcomes for activities of daily living and sports-related activities. Typically, patients can expect to return to sport by 6 months with continued improvement for a year following the surgery. Posterior thigh numbness and superficial skin infection are the most common adverse events. This chapter provides key clinical exam findings to aid in diagnosis, a brief overview of the local anatomy, and describes the surgical procedure for Achilles allograft reconstruction for irreparable chronic avulsions of the proximal hamstring.