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Endoscopic Proximal Hamstring Repair

This is a technique video describing how to perform an endoscopic proximal hamstring repair, ischial bursectomy, and sciatic neurolysis. The endoscopic approach is a minimally-invasive technique that can limit postoperative complications, decrease nerve injury rates, and improve technical visualization for anatomic repair while potentially allowing for a faster recovery. In this video, a patient with a right proximal hamstring tear of all three tendons (biceps femoris, semitendinosis, semimembranosus) is positioned prone with the leg abducted to move and protect the sciatic nerve laterally. A medial viewing portal is established followed by a lateral working portal. The ischial bursectomy and sciatic neurolysis is then performed. The arthroscope is then moved to a distal central portal and a proximal suture management portal is established. Anchors are placed in the ischium and sutures are passed through the tendon. Finally, the tendon is reduced and sutures are secured for final fixation. A variety of anchor and suture techniques may be used - in this video we show a double-row (transosseous-equivalent) method, placing the primary row inferolateral with tied horizontal mattress sutures, then pass those sutures into a knotless construct superomedial to reapproximate the entire anatomic footprints of the tendon origins.