Hamstring Injuries in the Athlete

Chu, Samuel Kai Wah; Rho, Monica

doi:10.1249/jsr.0000000000000264

Cited by 87 publications

(51 citation statements)

References 62 publications

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“…6,8 Both patient-reported outcomes and diminished failure rates for acute intervention in retracted tendon avulsions (≥2 cm) as well as for chronic symptomatic partial tears continue to markedly outperform those associated with nonoperative management. 1,4…”

mentioning

confidence: 99%

Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Gerhardt

Assenmacher

Chahla

2019

Orthopaedic Journal of Sports Medicine

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Background:Despite an abundance of literature regarding construct strength for a myriad of anchors and anchor configurations in the shoulder, there remains a paucity of biomechanical studies detailing the efficacy of these implants for proximal hamstring repair.Purpose:To biomechanically evaluate the ultimate failure load and failure mechanism of knotless and knotted anchor configurations for hamstring repair.Study Design:Controlled laboratory study.Methods:A total of 17 cadaveric specimens divided into 3 groups composed of intact hamstring tendons as well as 2 different anchor configurations (all-knotted and all-knotless) underwent first cyclic loading and subsequent maximal loading to failure. This protocol entailed a 10-N preload, followed by 100 cycles incrementally applied from 20 to 200 N at a frequency of 0.5 Hz, and ultimately followed by a load to failure with a loading rate of 33 mm/s. The ultimate failure load and mechanism of failure were recorded for each specimen, as was the maximal displacement of each bone-tendon interface subsequent to maximal loading. Analysis of variance was employed to calculate differences in the maximal load to failure as well as the maximal displacement between the 3 study groups. Holm-Sidak post hoc analysis was applied when necessary.Results:The all-knotless suture anchor construct failed at the highest maximal load of the 3 groups (767.18 ± 93.50 N), including that for the intact tendon group (750.58 ± 172.22 N). There was no statistically significant difference between the all-knotless and intact tendon groups; however, there was a statistically significant difference in load to failure when the all-knotless construct was compared with the all-knotted technique (549.56 ± 20.74 N) (P = .024). The most common mode of failure in both repair groups was at the suture-tendon interface, whereas the intact tendon group most frequently failed via avulsion of the tendon from its insertion site.Conclusion:Under biomechanical laboratory testing conditions, proximal hamstring repair using all-knotless suture anchors outperformed the all-knotted suture anchor configuration with regard to elongation during cyclic loading and maximal load to failure. Failure in the all-knotted repair group was at the suture-tendon interface in most cases, whereas the all-knotless construct failed most frequently at the musculotendinous junction.Clinical Relevance:No biomechanical studies have clearly identified the optimal anchor configuration to avert proximal hamstring repair failure. Delineating this ideal suture anchor construct and its strength compared with an intact hamstring tendon may alter the current standards for postoperative rehabilitation, which remain extremely conservative and onerous for these patients.

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confidence: 99%

Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Gerhardt

Assenmacher

Chahla

2019

Orthopaedic Journal of Sports Medicine

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“…Furthermore, clinical, MRI, and US determinants were established in the literature that have an effect on the time to return to play after HMC injury in athletes [16]. On the other hand, it is important to realize that for an individual HMC injury, none of these MRI and US determinants show a direct correlation with the time to return to play [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Imaging has a role in confirming the site of injury and characterizing its extent, providing some prognostic information and helping plan treatment [8]. In this regard, both magnetic resonance imaging (MRI) and ultrasonography (US) have been shown to be effective for identification of hamstring strains and tendinopathy (e.g., [12–15]). Both MRI and US provide detailed information about the HMC with respect to localization and characterization of injury [13].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent systematic review [16], several clinical, MRI, and US determinants were determined that are associated with a longer recovery time in nonoperative management of acute HMC injury (summarized in Table 1). However, it is important to realize that for an individual HMC injury, none of these MRI and US determinants show a direct correlation with the time to return to play [14, 15]. Accordingly, the prognosis of HMC injuries should not be guided by imaging findings alone [14].…”

Section: Introductionmentioning

confidence: 99%

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Is radial extracorporeal shock wave therapy combined with a specific rehabilitation program (rESWT + RP) more effective than sham-rESWT + RP for acute hamstring muscle complex injury type 3b in athletes? Study protocol for a prospective, randomized, double-blind, sham-controlled single centre trial

Crupnik¹,

Silveti²,

Wajnstein³

et al. 2019

J Orthop Surg Res

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Background Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. Methods We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. Discussion Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. Trial registration ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.

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“…Proximal hamstring tendinopathy (PHT) is a common overuse injury that can cause significant dysfunction and be challenging to treat. 56,57 Although it has been described in less active individuals, it primarily affects athletic populations, especially endurance runners, sprinters, and hurdlers. 56,58,59 Similar to gluteal tendinopathy, the primary pathology of PHT is degenerative tendinosis and partial tear due to cumulative microtrauma.…”

Section: Prp For Proximal Hamstring Tendinopathymentioning

confidence: 99%

Orthobiologics for the Hip Region: A Narrative Review

McInnis

Chen

Finnoff

et al. 2020

PM&R

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Management of hip region disorders is challenging. Orthobiologic treatments including platelet rich plasma (PRP), mesenchymal stem cells, and amniotic injectables have gained popularity as promising treatments despite a lack of robust evidence for their effectiveness. We review rationale and current evidence for orthobiologics for three common hip region conditions: hip osteoarthritis, gluteal tendinopathy, and proximal hamstring tendinopathy. Overall, the current state of evidence is extremely limited for orthobiologic treatments and is predominantly relevant to PRP injections. There is currently a lack of data to support the use of mesenchymal stem cells or amniotic injectables in these conditions of the hip. the use of orthobiologics in the treatment of three common diagnoses affecting the hip region: osteoarthritis (OA), gluteal tendinopathy, and proximal hamstring tendinopathy (PHT). Methods A review was conducted of PubMed and Medline articles from January 2000 to June 2019 with search terms including hip, osteoarthritis, gluteal tendonitis, hamstring tendonitis, tendinosis, tendinopathy, platelet rich plasma, mesenchymal stem cell, amniotic stem cell, and amniotic injectables. Randomized controlled trials, case series, systematic reviews, and meta-analyses were reviewed. Only studies investigating chronic refractory tendinopathy and osteoarthritis were included. We did not include studies investigating acute muscle, myotendinous injury, acetabular labral pathology, or focal osteochondral lesion. Platelet Rich Plasma PRP is an autologous plasma concentrate containing platelets above physiologic concentrations in whole blood. Platelets are thought to initiate the healing cascade by forming a fibrin matrix, which serves as a tissue

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Hamstring Injuries in the Athlete

Cited by 87 publications

References 62 publications

Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Is radial extracorporeal shock wave therapy combined with a specific rehabilitation program (rESWT + RP) more effective than sham-rESWT + RP for acute hamstring muscle complex injury type 3b in athletes? Study protocol for a prospective, randomized, double-blind, sham-controlled single centre trial

Orthobiologics for the Hip Region: A Narrative Review

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