Thanks for the invitation. So I just want to talk a little bit about something that's been emerging over the last few years. First of all, my disclosures are on the Academy website and they're not pertinent to this talk. The first thing that I'm going to mention with the endoscopic hamstring repair is the fact that visualization in my mind is so much better. In particular, the sciatic nerve exposure is really something that I've really gained a lot of confidence in managing these patients because of my ability to localize the nerve. I think the other thing that has made me more comfortable with these is to be able to treat these patients in their continuum, anywhere from a strain to an avulsion. I think we're all, when we think of hamstrings, we think of a massive tear, but I think more important and probably a bigger part of my population is the patients that have partial tears and sort of chronic ischial bursitis and sciatic symptomatology, and I think it's much easier determination endoscopically in these patients. And sort of the final group is ischiofemoral impingement, which we're not going to talk about today, but that's something that's emerging as well. And so you can take something like this that looks to be pretty messy and you can clean it up, make it look just like a rotator cuff repair. In many cases if you turn your head sideways, put your suture anchors in and do a pretty nice repair, all while visualizing the sciatic nerve. One of the nice things that I've been able to figure out is the anatomy really is a little bit different than what all the textbooks kind of tell you. And so you can kind of see that there's actually a totally separate attachment for the common tendon as well as semimembranosus. And so for years I think it's been confused as one big amalgam of tissues, but really it's two separate areas to look for. And sciatic nerve is always in play. You should always look for it. I always look for it in my cases, push it aside, look at it while you're working to make sure that you don't do any damage. And just to show a quick video, it's about a two and a half minute video, just showing here's an example. This is a physical therapist that was running with her stroller pushing her child and slipped and had this acute avulsion. I was able to get to her about a month out post-op. This is my standard portals. Now sometimes I will do a more proximal portal above the ischium. And we can see here, one of the things that you first see a lot of times is what looks to be the sciatic nerve. In this case, in fact, it was really just posterior cutaneous. So as you keep looking around the corner, sort of behind the ischium and around the hamstring origin, you can kind of start to see that there's actually a bigger tissue back there. And that's where the sciatic nerve was. So in this patient, I thought it was particularly important to really do this endoscopically because I think it would have been a hard procedure to do. And you can see, I think the beauty again is as we see all the steps here, and I don't need to go through the steps because these are pretty obvious, and you can use any variety of suture penetrator or suture passing devices. But I think the most important point in this case is to look throughout the case, you can see the sciatic nerve. You can see the posterior cutaneous, which I would venture to say that in an open fashion, that's really tough to do, to really keep that stuff in mind and to keep it in the view in such a clean fashion. Here's another example. This was a relatively acute tear also. You can kind of see the big defect in the origin there, and she had actually had a lot of sciatic nerve symptoms over the last six weeks after the injury. And so as I started to dissect it out and try to find the nerve, you can see that in this case, it was actually sort of caught in this whole process, and so I have a few of these endoscopic general surgery instruments that we can use to really create a nice mobilization. And so when you're done with this, then you can be really sure that you've really done a good job with the endoscopic approach and really decompress that nerve very effectively in cases where you need it. This is another neat case that I did recently, a patient that had calcific tendonitis, which I think would have been, again, historically a little bit harder to do in an open fashion. And you can see it looks just like a rotator cuff. This guy was actually an acrobatic horse enthusiast. I'll show you the videos later, but you can do a pretty nice endoscopic repair on somebody like this in a minimally invasive fashion. There are some studies coming out now. There's a couple. This one, for example, had 30 patients with about 95% satisfaction rate, 1% or 2% incidence of cutaneous innervation issues, no significant complications. Same thing. This is another series with 20 patients. And so there are several series coming out now. And then I think the other big thing that's been worked out pretty well has been the fact that we know where the portals need to be. You want to start the medial portal first, make sure that you've got good visualization of the lateral aspect where the danger zone is, and avoid the posterior cutaneous and the sciatic nerve. So it's fairly straightforward if you look at this anatomy. Whoa. So, in summary, it's a procedure in evolution. In my mind, in my office, my indications are pretty much all the partial tears I do endoscopically, and probably more and more of the full thickness tears I'm able to approach endoscopically as well. Certainly, the patients with chronic bursitis, and anybody that has sciatic nerve issues that need a decompression, I think that's the right patient. Thank you.

endoscopic hamstring repair

improved visualization

sciatic nerve exposure

hamstring injuries

patient satisfaction rates