Open Hamstring Tendon Excision Following a Distal Semitendinosus Avulsion Tear: A Technique Video

Abstract

Background: Hamstring injuries are commonly considered the number one reason for delayed return to play and return to sport (RTS) across several sport disciplines. Traditionally, they are treated conservatively. However, recent literature has shown surgical intervention to improve recovery and expedite RTS. One potential explanation behind this phenomenon is conservative treatment does not address the disrupted length-tendon relationship, which can cause hamstring re-injury. Indications: Operative indications for tendon excision include patients with distal semitendinosus avulsions tear with retraction, especially patients who had already failed conservative management. Elite athletes with distal hamstring tears who have experienced a delayed RTS or desired activity level should also be considered for distal hamstring excision. Technique Description: A distal 4-cm incision, which was longitudinal in line with the semitendinosus, was made over the posterior knee at the measured level of the avulsed tendon stump, 2 cm proximal to the knee flexion crease. Blunt dissection was used for the subcutaneous layers, and the overlying hypertrophic and fibrotic tendon sheath was sharply incised. The torn and retracted tendon tissue was exteriorized. An allis clamp was used to provide tension on the distal semitendinosus, and mobilization of the avulsed tendon was performed. Sheath tissue surrounding the injured tendon was removed. The stump was whipstitched to provide further traction, and the hypertrophied portion of the tendon was excised. An open tendon stripper was implemented to exercise both limbs of the semitendinosus. The subcutaneous tissue and skin were closed, and an incisional wound vac was placed. Discussion/Conclusion: Distal avulsion tears of semitendinosus tendons can lead to unsatisfactory results with conservative treatment, with delayed RTS and recurrence of symptoms. Resection of hamstring tendon tissue may eliminate the recurrence of injury, along with inflammation, fibrosis, and hemorrhage associated with retraction reinjuries. Patient Consent Disclosure Statement: 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.