title: Nerve Wrapping of the Sciatic Nerve With Acellular Dermal Matrix in Chronic Complete Proximal Hamstring Ruptures and Ischial Apophyseal Avulsion Fractures.
abstract: BACKGROUND
  Patients with chronic injuries of the proximal hamstring can develop significant impairment because of weakness of the hamstring muscles, sciatic nerve compression from scar formation, or myositis ossificans.
  
  
  OBJECTIVE
  To describe the surgical outcomes of patients with chronic injury of the proximal hamstrings who were treated with hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix.
  
  
  METHODS
  Retrospective case series; Level of evidence, 4.
  
  
  METHODS
  Fifteen consecutive patients with a diagnosis of chronic complete proximal hamstring rupture or chronic ischial tuberosity apophyseal avulsion fracture (mean age, 39.67 years; range, 14-69 years) were treated with proximal hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix. Nine patients had preoperative sciatica, and 6 did not. Retrospective chart review recorded clinical outcomes measured by the degree of pain relief, the rate of return to activities, and associated postoperative complications.
  
  
  RESULTS
  All 15 patients were followed in the postoperative period for an average of 16.6 months. Postoperatively, there were 4 cases of transient sciatic nerve neurapraxia. Four patients (26%) required postoperative betamethasone sodium phosphate (Celestone Soluspan) injectable suspension USP 6 mg/mL. Among the 9 patients with preoperative sciatica, 6 (66%) had a good or excellent outcome and were able to return to their respective activities/sports; 3 (33%) had persistent chronic pain. One of these had persistent sciatic neuropathy that required 2 surgical reexplorations and scar excision after development of recurrent extraneural scar formation. Among the 6 without preoperative sciatica, 100% had a good or excellent outcomes and 83% returned to their respective activities/sports. Better outcomes were observed in younger patients, as the 3 cases of persistent chronic sciatic pain were in patients older than 45 years.
  
  
  CONCLUSIONS
  This study suggests that when used as an adjunct to sciatic neurolysis, nerve wrapping with acellular dermal matrix can be a safe and effective method of treating younger patients with and preventing the development of sciatic neuropathic pain after chronic injury of the proximal hamstrings.
authors.affiliation: University of California-Davis Children's Hospital, Shriners Hospital for Children, Northern California, Sacramento, California, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Haus
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Arora
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Upton
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Micheli
keywords: acellular dermal matrix; hamstring avulsion; neurolysis