. 2021 Apr 18;10(5):e1307–e1313. doi: 10.1016/j.eats.2021.01.028

Table 2.

Pearls and Pitfalls of Allograft Augmentation Repair/Reconstruction of Chronic Proximal Hamstring Avulsion Injury

Pearls	Pitfalls
Correct knowledge of anatomy is key as adhesions in chronic injuries distort the anatomy making mobilization of the retracted tendon stump and sciatic nerve neurolysis more technically challenging. A longitudinal incision is recommended due to often significant tendon retraction in chronic injuries. Fixation with 5 suture anchors better reproduces native hamstring tendon attachment and strength. Small anchors may be used if the use of 5 suture anchors is not permitted by space. Graft fixation with the knee in 90° flexion decreases the length of gap needed to bridge. Additionally, bracing in 90° flexion postoperatively protects the reconstruction.	In chronic injuries, tendon retraction often precludes a direct repair. In these cases, allograft augmentation is often necessary. Significant adhesions and tendon retraction distort the anatomy in chronic injuries. Care must be taken to identify all neurovascular structures to avoid iatrogenic injury.

Pearls

Pitfalls

Correct knowledge of anatomy is key as adhesions in chronic injuries distort the anatomy making mobilization of the retracted tendon stump and sciatic nerve neurolysis more technically challenging.
A longitudinal incision is recommended due to often significant tendon retraction in chronic injuries.
Fixation with 5 suture anchors better reproduces native hamstring tendon attachment and strength. Small anchors may be used if the use of 5 suture anchors is not permitted by space.
Graft fixation with the knee in 90° flexion decreases the length of gap needed to bridge. Additionally, bracing in 90° flexion postoperatively protects the reconstruction.

In chronic injuries, tendon retraction often precludes a direct repair. In these cases, allograft augmentation is often necessary.
Significant adhesions and tendon retraction distort the anatomy in chronic injuries. Care must be taken to identify all neurovascular structures to avoid iatrogenic injury.