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Minimal-invasive endoskopische Rekonstruktion der proximalen Hamstring-Insertion

Minimally invasive proximal hamstring insertion repair

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Zusammenfassung

Operationsziel

Minimal-invasive endoskopische Rekonstruktion von Avulsionsverletzungen der proximalen Hamstring-Insertion zur Vermeidung von persistierender Schwäche und Schmerzen.

Indikationen

Frische retrahierte 2‑ und 3‑Sehnen-Avulsionsverletzungen der proximalen Hamstring-Insertion. Frustrane konservative Therapie wenig retrahierter Verletzungen. Schmerzhafte chronische Partialläsionen der proximalen Hamstring-Insertion.

Kontraindikationen

Wesentliche Komorbiditäten mit erhöhtem Operationsrisiko, ältere Patienten mit niedrigem funktionellem Anspruch und chronische Verletzungen ohne funktionelle Defizite.

Operationstechnik

Endoskopische Refixation mit Fadenankern nach Anfrischen des Footprint am Tuber ischiadicum. Visualisierung des Nervus ischiadicus zur sicheren Schonung.

Weiterbehandlung

Teilbelastung mit Kniegelenkorthese zur strikten Vermeidung einer kombinierten Kniestreckung und Hüftgelenkflexion für 4–6 Wochen. Beginn der aktiven Beübung und Dehnung 8 Wochen postoperativ.

Ergebnisse

Im Zeitraum von 2014–2016 wurden 12 Patienten mit einer endoskopischen Rekonstruktion der proximalen Hamstring-Insertion behandelt. Bei einer mittleren Nachuntersuchungszeit von 25 Monaten (Spanne 16–34 Monate) zeigten sich auf der visuellen Analogskala ein durchschnittlicher VAS von 0 (Spanne 0–2) und eine durchschnittliche subjektive Bewertung der Funktion („Subjective Hip Value“) von 94 % (Spanne 80–100 %). In unserem Kollektiv zeigten sich keine neurovaskulären Komplikationen, insbesondere keine Hinweise auf Hypästhesien im Bereich des N. cutaneus femoris posterior. Alle Patienten konnten zu ihrem ursprünglichen Aktivitätsniveau zurückkehren (Tegner Activity Scale 5,2 präoperativ vs. 5,2 postoperativ). Die durchschnittliche Dauer bis zum „Return to Sport“ betrug 6,5 Monate (Spanne 3–12 Monate). Alle Patienten konnten ihren ursprünglichen Beruf weiter ausüben.

Abstract

Objective

Minimally invasive endoscopic reconstruction of avulsion injuries of the proximal hamstring insertion to prevent persistent weakness and pain.

Indications

Fresh retracted 2‑ and 3‑tendon avulsion injuries of the proximal hamstring insertion. Unsuccessful conservative therapy of less retracted injuries. Painful chronic partial lesions of the proximal hamstring insertion.

Contraindications

Major comorbidities with an increased surgical risk, older patients with low functional demands. Chronic injuries without functional deficits.

Surgical technique

Endoscopic refixation using suture anchors after freshening the footprint on the tuber ischiadicum. Visualization of the sciatic nerve to ensure its protection.

Postoperative management

Partial loading with a knee brace for strict prevention of combined knee extension and hip flexion for 4–6 weeks. Start of active exercise and stretching 8 weeks postoperatively.

Results

From 2014–2016, 12 patients were treated with an endoscopic reconstruction of the proximal hamstring insertion. After a mean follow-up of 25 months (range 16–34 months), an average visual analog scale (VAS) of 0 (range 0–2) and an average subjective assessment of function (Subjective Hip Value) of 94% (range 80–100%) were found. No neurovascular complications were seen in our collective, in particular no evidence of hypesthesia in the area of the posterior femoral cutaneous nerve. All patients were able to return to their original level of activity (Tegner Activity Scale 5.2 preoperatively vs. 5.2 postoperatively), while the average time until return to sport was 6.5 months (range 3–12 months). All patients were able to return to their original occupation.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    J. H. Schröder, M. Schütz, C. Perka & D. R. Krüger

  2. Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland

    M. Gesslein

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  1. J. H. Schröder
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Correspondence to J. H. Schröder.

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Interessenkonflikt

J.H. Schröder, M. Gesslein, M. Schütz, C. Perka und D.R. Krüger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schröder, J.H., Gesslein, M., Schütz, M. et al. Minimal-invasive endoskopische Rekonstruktion der proximalen Hamstring-Insertion. Oper Orthop Traumatol 30, 419–434 (2018). https://doi.org/10.1007/s00064-018-0575-3

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