Proximal Origin of the Hamstring Muscle Group

Abstract

It was with great interest that we read the recent article in Arthroscopy Techniques by Dierckman and Guanche, describing a technique for endoscopic proximal hamstring repair.1Dierckman B. Guanche C. Endoscopic proximal hamstring repair and ischial bursectomy.Arthrosc Tech. 2012; 1: e201-e207https://doi.org/10.1016/j.eats.2012.07.005Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar The notion of addressing such injuries endoscopically is very appealing, considering the minimally invasive nature of this surgical technique and the potential for an expeditious recovery. It is important to recognize that in endoscopic surgery, achieving satisfactory exposure of relevant anatomic structures can be challenging. Therefore, a thorough and unequivocal knowledge of anatomy is essential to ensure satisfactory results. The authors should be commended for their detailed and comprehensive account of the surgical technique for this novel procedure. However, in Figure 1 in their article, which outlines a cadaveric dissection of the left hip, the footprint of the semimembranosus is mislabeled as the footprint of the common origin of the long head of biceps femoris and semitendinosus. In addition, the authors describe the footprint of the common origin as being crescent shaped, which would conflict with the findings of Miller et al., who, in their anatomic study, described this footprint as being oval.2Miller S. Gill J. Webb G. The proximal origin of the hamstrings and surrounding anatomy encountered during repair: A cadaveric study.J Bone Joint Surg Am. 2007; 805: 44-48Crossref Scopus (103) Google Scholar In the same study, the footprint of the semimembranosus is described as crescent shaped.2Miller S. Gill J. Webb G. The proximal origin of the hamstrings and surrounding anatomy encountered during repair: A cadaveric study.J Bone Joint Surg Am. 2007; 805: 44-48Crossref Scopus (103) Google Scholar Interestingly, this error is not uncommon. In the recent literature, there are a number of examples of mislabeled diagrams regarding the attachment sites of the proximal hamstrings.3Cohen S. Bradley J. Acute proximal hamstring rupture.J Am Acad Orthop Surg. 2007; 15: 350-355PubMed Google Scholar, 4Pombo M. Bradley J.P. Proximal hamstring avulsion injuries: A technique note on surgical repairs.Sports Health. 2009; 1: 261-264Crossref PubMed Scopus (21) Google Scholar These inaccuracies perhaps contribute to the confusion regarding the anatomic location of these footprints. We would like to emphasize that in pointing out these small discrepancies, we are merely aiming to be of assistance to the authors. We are by no means critical of this technique, which we believe to be innovative and of great benefit to the continued development of endoscopic hip surgery. Endoscopic Proximal Hamstring Repair and Ischial BursectomyArthroscopy TechniquesVol. 1Issue 2PreviewWith the significant increase in use of the arthroscope around the hip have come several less invasive techniques to manage pathologies around this joint. This technical note with a video details one such technique that allows for the endoscopic management of proximal hamstring tears and chronic ischial bursitis, which until now have been managed exclusively with much larger open approaches. This procedure allows for complete exposure of the posterior aspect of the hip in a safe, minimally invasive fashion. Full-Text PDF Open AccessAuthors' ReplyArthroscopyVol. 29Issue 11PreviewWe wish to begin by thanking Drs. Ferro and Devitt for their detailed response and say that we appreciate their feedback. As they noted, there have been varying and conflicting published reports on the anatomy of the proximal hamstring insertion. The authors base their comment that “there are a number of examples of mislabeled diagrams” by citing the article by Miller et al., making the assumption that this article indeed reports the “correct” anatomic description. However, based on our experience both clinically (open and arthroscopically) and with cadaveric specimens, we feel the anatomy is more accurately reflected by the description we provided in our article and those provided by Dr. Full-Text PDF