Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment

Abstract

Background:As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings.Purpose:To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes.Study Design:Case series; Level of evidence, 4.Methods:Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored.Results:Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up.Conclusion:Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play

“…The clinical relevance of intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine 1–7. Studies that report return to play (RTP) duration and reinjury rates for this injury subtype vary from a mean of 25.3 (±8.6) to 84 (±49.4) days and reinjury rates from 17% to 57% for the same grade of injury 3 4.…”

Chronic and Recurrent Rectus Femoris Central Tendon Ruptures in Athletes: Clinical Picture, MRI Findings, and Results of Surgical Treatment

“…Therefore, follow-up MRI should be considered after 2 weeks of the central tendon injury if clinical symptoms continue and severe central tendon injury is suspected. 11 …”

“…Therefore, follow-up MRI should be considered after 2 weeks of the central tendon injury if clinical symptoms continue and severe central tendon injury is suspected. 11 The physician should look for the central tendon injury to evaluate the return-to-play time and the rehabilitation protocol; thus, injuries involving the tendon take more time to heal than typical rectus femoris muscle tissue injuries. 4 So far, there have been no surgical treatment indications for chronic and recurrent rectus femoris central tendon ruptures.…”

“…This Z-plasty technique is demonstrated by schematic drawings in an earlier study dealing with recurrent biceps femoris central tendon ruptures. 11 An active stretching program to the operated anterior thigh was avoided for 2 to 3 weeks to allow the repaired area to heal properly. No hip or knee braces were used, and the patient was allowed immediate mobilization with weightbearing as tolerated with crutches.…”

“…1,4,5 While more information has been recently published about the surgical treatment of biceps femoris central tendon injury, there is scarce information in the literature regarding rectus femoris central tendon injuries. 1,4,5,11 The main goals of this study are to increase the knowledge of this special rectus femoris injury type and present the results of surgical treatment in rectus femoris central tendon ruptures. The clinical picture of rectus femoris central tendon injury, typical MRI findings, and surgical technique are clarified as well.…”