Radiographic localization of the proximal hamstring tendon footprint relative to ischial landmarks: a cadaveric analysis supporting endoscopic repair

Abstract This cadaveric radiographic study aimed to define the proximal hamstring footprint using reproducible ischial landmarks and to compare pelvis and hip posterior–anterior (PA) radiographs in depicting its borders. The goal was to provide practical reference values to guide anatomical anchor placement during endoscopic repair. A total of 10 hips (from five formaldehyde-fixed cadavers) were examined. Marking pins were placed at the proximal hamstring tendon footprint to identify anatomical boundaries. Pelvis PA and hip PA radiographs were obtained to determine the radiological borders and their relationship with the ischial tuberosity. The distances from the superior, medial, lateral, and inferior borders of the tendon to the line connecting the ischial tuberosities and the ischial apex were measured. The pelvis and hip radiographs were compared using the Mann–Whitney U test. Four cadavers were male, with a mean age of 67 years. Distances from the tendon’s borders to the ischium and ischial apex were consistent across the pelvis and hip radiographs, with no statistically significant differences (P > 0.05). Median distances of tendon footprint borders ranged from 15.5 (IQR: 8.6) to 35.5 (IQR:5.4) mm for the ischial tuberosity line and 30.05 (IQR: 9.07) to 47.1 (IQR: 9.6) mm for the ischial apex. Similar results were observed in hip radiographs. Radiographic localisation of the proximal hamstring footprint is feasible and yields consistent measurements on both pelvic and hip PA views. These values offer practical anatomical guidance that may support more accurate anchor placement during endoscopic proximal hamstring repair.