Abstract
Objective
Calcific tendinopathy is characterised by intratendinous deposition of calcium-hydroxyapatite crystals that may trigger an intense inflammatory response. Although the rotator cuff is classically affected, peri-trochanteric calcifications are the second most common location and hamstring involvement remains anecdotal. We report the first endoscopic excision of a symptomatic calcific deposit at the hamstring origin and discuss technical pearls, pitfalls and early outcome.
Methods
A 62 year-old woman experienced disabling posterior hip pain for 24 months despite non-steroidal anti-inflammatory medication, physiotherapy, ultrasound guided corticosteroid and platelet-rich plasma injections and extracorporeal shock-wave therapy. Radiography, computed tomography and magnetic resonance imaging demonstrated a 1 × 2 cm calcification at the conjoint hamstring on the ischial tuberosity with an intact sciatic nerve. Endoscopic excision was performed through posterolateral and posteromedial portals with the patient prone and the knees flexed 20°–30°. The calcific focus was removed after a longitudinal tenotomy and the tendon was anatomically repaired using two suture anchors.
Results
Operating time was 65 minutes with negligible blood loss. The patient was discharged on postoperative day 1. At 6-month review the Visual Analogue Scale for pain improved from 8 to 1 and the Harris Hip Score from 37 to 95. Radiographs confirmed complete lesion clearance and there were no neurological or wound complications.
Conclusion
Endoscopy allows safe, minimally invasive excision of deep-seated hamstring calcifications while preserving surrounding soft tissues and enabling concurrent tendon repair under direct vision. It should be considered when exhaustive conservative treatment fails. Larger series and long-term data are required to define indications and outcomes.