Surgical Approach Impacts Posterior Femoral Cutaneous Nerve Outcomes After Proximal Hamstring Repair

OBJECTIVE: The goal of this study was to characterize the risk of intraoperative injury to the posterior femoral cutaneous nerve and to evaluate potential risk factors for injury during surgical repair of proximal hamstring injuries. DESIGN: Retrospective cohort study. SETTING: Single tertiary referral center. PATIENTS: The cohort consisted of all patients presenting to a single institution with a proximal hamstring avulsion injury who were managed with surgical repair between January 1, 2000 and August 1, 2016. A total of 67 patients were included in the cohort. INDEPENDENT VARIABLES: Variables assessed for their association with postoperative numbness in the distribution of the posterior femoral cutaneous nerve included age, sex, body mass index, mechanism of injury, time to surgical repair, and incision used. MAIN OUTCOME MEASURES: The primary outcome of interest was neurologic symptoms referable to the posterior femoral cutaneous nerve. RESULTS: Postoperatively, 13 patients (19%) developed new numbness in the distribution of the posterior femoral cutaneous nerve. One patient reported neuropathic pain and paresthesias associated with the numbness. The use of a gluteal crease incision was the only predictive factor for postoperative numbness in the posterior femoral cutaneous nerve distribution (odds ratio 8.67; 95% confidence interval, 2.30-42.80; P = 0.001). CONCLUSIONS: The current study provides data that can be used in discussing the risks and benefits of surgical repair with patients and when weighing the pros and cons of using a gluteal crease versus longitudinal incision.