Hamstring Muscle Injuries Among Water Skiers

Abstract

Water skiing is associated with severe injuries to the proximal hamstring muscles. We wanted to define the mechanism of injury, describe the associated pathologic changes, determine the functional limitations of patients, and suggest measures to prevent injury. Twelve patients with water skiing-related hamstring injuries were included. Six patients were experienced skiers and six were novices. The mechanism of injury was identical in five of six novice skiers. Each sustained the injury while attempting to get up on one or two skis from a submerged position. In contrast, the expert skiers all sustained injury secondary to a fall while skiing. Physical examination documented evidence of complete or partial avulsion of the proximal hamstring muscle origins in all patients. In addition, six patients had magnetic resonance imaging or computed tomography scans that confirmed the location and extent of the tear. Convalescence ranged from 3 months to 1.5 years before the patient could return to vigorous activities. Seven patients (58%) returned to most of their preinjury sports, albeit at a lower level. Five patients (42%), all with complete disruptions, were unable to run or participate in sports requiring agility. Two of these patients required delayed surgical repairs because of persistent functional limitations.

Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons

“…Nonoperative management is associated with poor outcomes and low rate of return to sports [9,11]. Delayed repair of tears may need larger incisions and extensive surgical exploration to identify the retracted ends of the severed musculo-tendinous region.…”

“…The poor results of nonoperative treatment [9] have encouraged sports surgeons to undertake early surgical repair [7]. We report the successful outcome of early surgical repair of complete tears of the proximal hamstring origin in ten athletes.…”

Acute Proximal Hamstring Rupture

“…The small numbers of published studies contain both acute and chronic tears and include a relatively small number of patients. [2][3][4][5][6][7] The findings in these studies are summarized in table 1.…”

“…[6] The mechanism was commonly an eccentric contraction while attempting to get up from the submerged position in novice skiers and injury from a fall in expert skiers. Initial treatment was non-operative and half of the patients had MRI or CT scans to assess the injury.…”

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

“…, 9,17 Non-operative management of proximal hamstring injuries is reserved for one or two tendon ruptures with ≤2 cm of retraction. 6 Conservative treatment is less successful for more significant injuries and acute surgical intervention is recommended for 1) two tendon avulsion with >2 cm of retraction, and 2) complete three tendon tears regardless of the extent of retraction.…”