Table 1.

Key Points for Dry Endoscopic-Assisted Mini-Open Hamstring Repair

Indications

Chronic hamstring origin tears

Ischial tunnel syndrome

Advantages

The surgeon can view the pathologic area under magnification.

The technique is less technically demanding than full-endoscopic approaches.

Accurate anchor placement can be achieved.

A lesser trochanterplasty for concomitant ischiofemoral impingement can be performed.

The risk of wound infection is theoretically lower than that with full-open procedures and comparable with full-endoscopic techniques.

The sciatic nerve can be protected under direct visualization.

Sciatic nerve decompression can be achieved.

There is no risk of unrecognized fluid extravasation.

Disadvantages

Large retracted tears might not be able to be addressed.

Theoretical risks

Wound infection

Retear

Nerve damage

Vascular damage

Nonaesthetic scar

Tips and pearls

Accurate diagnosis of hamstring origin tears should be made through a comprehensive history, physical examination, and radiologic evaluation.

The surgeon should ensure that the injury can be addressed with the mini-open technique.

A concomitant diagnosis of ischiofemoral impingement should be defined before surgery.

Neurophysiological monitoring should be used.

The incision should be guided by fluoroscopy.

The incision should travel superolaterally to inferomedially to have a better attack angle for anchor placement.

A hermetic dressing should be used because the incision is close to the perianal zone.

Pitfalls

Failure to diagnose concomitant ischiofemoral impingement

Failure to accurately identify hamstring proximal attachment site

Under-tensioning of repair

Use of technique for large tears including those of myotendinous junction