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THE PROXIMAL HAMSTRINGS are a group of muscles that originate from the ischium of the pelvis and attach to both the proxima l tibia a nd the fibula r head. These groups of muscles provide knee flexion streng th, as well as a…ecting pelvic tilt, ba lance, and rotation. A lthough injuries to this area are relatively rare, a tear of the origin of these tendons can be debilitating for patients. The most common mechanism of injury in patients suf- fering from a proxima l hamstring tear is sudden hip flexion with knee extension. Patients typically present with pain over the posterior ischium combined with significant ecchymosis and weakness in knee flexion in the days following the injury. Recently, attention has been given to the treatment of this injury endoscopica lly. Classica lly, operative repair would require a long incision in the gluteal crease with open repair of the tendon with the use of suture anchors. Several authors have described endoscopic techniques for the treatment of this injury with the use of a three porta l technique. The advantages of this technique include less morbidity, pain, and blood loss as well as an easier rehabilitation post operatively. We describe the case of a 39-yea r-old fema le who was roller skating with her daughter. She sustained the injury when the roller skate slipped causing her hip to go into hyperflexion with extension of the knee. She felt a popping and tearing sensation over her ischium and was unable to walk for several days. She was unable to go up and down stairs norma lly and was a lso unable to sit in a chair for more than fifteen minutes. Her radiographic evaluation showed no bony avulsions, so an MRI was ordered to eva luate the proxima l hamstrings. The MRI demonstrated a 50 percent tear of the semitendinosis and biceps femoris tendons avulsed from the ischium. She completed a long course of conservative treatment preoperatively, including physica l therapy and activity modification, and then opted for endoscopic repair of the tendon. The tear was addressed endoscopically via a three-portal technique with the patient in the prone position. A centra l viewing por ta l was created followed by both media l a nd latera l working por ta ls. The tendon was split centra lly, a nd a 4.5mm a nchor wa s placed into the ischium. The tendons were repaired using a horizontal mattress technique, which provided rigid fixation of the tendon. The patient was discharged from same day surgery and required no narcotics By Jovan R. Laskovski, MD of Proximal Hamstring Tears Endoscopic Repair post operatively. The patient rehabilitated with physica l therapy and regained full streng th of the hamstring tendons at three months post operatively without any residua l pain. The anatomy of the proxima l hamstrings and the deep glutea l space a llow us to be able to address these injuries endoscopica lly. However, in order for us to consider endo- scopic treatment, ca reful attention must be pa id to the anatomy, chronicity, and severity of the tear. The sciatic nerve runs latera lly with the proxima l hamstrings and, in a chronic tear, it can become scarred to the tendon requiring a neuroplasty with lysis of adhesions. A lso, chronic tears may need to be treated with a possible a llograft transplant, which would require an open approach at this time. Dr. Jovan Laskovski is a board-certifiedšorthopedic sur- geonšfellowship trained in sports medicine and arthroscopy with a particular focus on hip arthroscopy. He is a member of Crystal Clinic and practices at Crystal Clinic Orthopaedic Center on 1622 E. Turkeyfoot Road in Akron, OH. ■ Proximal hamstring tear exposed endoscopically Repaired hamstring tendon tear 1 2 1 2C L I N I C A L S E C T I O N