Editorial Commentary: Endoscopic Treatment of Hamstring Pathology Shows Positive Patient Outcomes.

Abstract

Hamstring pathology is both a common, and commonly missed, source of pain. Acute traumatic tears can be missed or underappreciated, and hamstring tendinopathy and partial-thickness tears are often atraumatic with insidious onset. Partial-thickness hamstring tears or tendinopathy can be underappreciated on magnetic resonance imaging or missed in conjunction with concomitant pathology. Ultrasound-guided diagnostic injections are invaluable tools when sorting through concomitant pathologic processes. If noninvasive treatment options are unsuccessful, injections and surgery are options. Corticosteroid injections have limited utility; platelet-rich plasma injections have shown promise. When surgical treatment is warranted, both endoscopic and open techniques allow for improvement. Although technically demanding, endoscopic hamstring repair allows minimally invasive access to the entirety of the ischial tuberosity, magnified viewing of the tendon structure, and the ability to visualize both the sciatic nerve as well as the posterior femoral cutaneous nerve. These latter 2 structures are most at risk. Maintaining orientation with fluoroscopy enhances arthroscopic understanding of the deep gluteal space, with the posterior aspect of the ischium acting as a safe zone from which careful surgical dissection can begin.