Table 1.

Pearls and Pitfalls

Pearls	Pitfalls
Make an incision in the gluteal crease to improve cosmesis and provide direct access to the ischial tuberosity.	Failing to fully expose ischial tuberosity and retracted tendon, limiting visualization and anchor placement
Follow the hematoma to identify the retracted tendon; it typically localizes the avulsion site.	Drilling anchors without identifying and protecting sciatic nerve, increasing risk of iatrogenic injury
Identify the sciatic nerve early; retract gently with a vessel loop or malleable retractor to prevent traction injury.	Failing to thoroughly debride ischial footprint, which can impair tendon healing and integration
Place 3 Q-Fix anchors in a triangular configuration to maximize footprint coverage and force distribution.	Passing sutures through compromised tendon or too close to edge, reducing repair strength and increasing risk of suture pullout
Pass suture limbs in a tension-slide configuration to optimize tendon-to-bone compression.	Using thin sutures instead of tape in degenerative tendon, increasing risk of cut-through
Use suture tape instead of round sutures to reduce the risk of tendon cut-through and improve contact pressure.	Failing to apply postoperative bracing when tendon is difficult to reduce, placing repair at higher risk of failure
Apply a hinged knee or hip brace postoperatively when tendon reduction is under tension or difficult to achieve intraoperatively.