Table 3.

Surgical Pearls, Pitfalls, Risks, and Limitations

Pearls
A thorough diagnostic endoscopy will reveal what else can be done to remove pain
generators.
Appropriate sciatic neurolysis is recommended.
Ensure the direct posterior portal will provide appropriate trajectory for overlying the
graft on the proximal hamstring origin.
Accessory portal 3-4 fingerbreadths proximal to direct posterior portal will aid in staple
fixation.
A skid may facilitate graft passage.
A minimum of 6 staples are required for graft stability.
Pitfalls
Poor patient selection (differential includes lumbar radiculopathy, ischiofemoral
impingement, deep gluteal syndrome) can lead to suboptimal results.
Inadequate accessory portal placement can lead to staple misfire.
Risks and limitations
The sciatic nerve is at risk and should be identified, neurolysis performed, and protected throughout the entire procedure.
This procedure is indicated for patients who have exhausted a thorough trial of nonoperative management and should not be first line treatment for symptomatic partial proximal hamstring tears