Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Abstract

Background: Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. Purpose: To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Study Design: Case series; Level of evidence, 4. Methods: The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. Results: There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in the operative extremity with activities of daily living. No patient underwent a subsequent surgery. One patient was not satisfied with the result and reported persistent symptoms during competitive distance running. All patients were able to return to their preoperative level of activity after surgery. Conclusion: Anatomic surgical treatment of partial proximal hamstring avulsions can lead to satisfactory functional outcomes, a high rate of return to athletic activity, and low complication rate. This procedure should be reserved for patients who have failed an extended course of nonoperative treatment, and the proximity of the sciatic nerve mandates a careful assessment of the risk-benefit ratio before surgery is undertaken.

Surgical repair of a rupture of the pectoralis major muscle

“…Few authors have described good results using surgery to treat rupture of the anterior thigh or other muscles 2 5 6…”

Hip Imaging in Athletes: Sports Imaging Series

“…Sagittal and coronal oblique planes (perpendicular to the aponeurosis) with a small field of view are recommended (171). In case of an injury, separation of the aponeurotic plate from the pubic bone inferolateral forms a secondary treatment (166). An interesting anatomic observation is the continuity of the sacrotuberous ligament with the ischium and the conjoint tendon (biceps femoris and semitendinosus) but not with the semimembranosus tendon (165).…”

Beckennahe Sehnenverletzungen

“…Die Rekonstruktion von akuten Verletzungen zeigt leicht bessere Resultate als nach chronischen Rupturen [13]. Nach operativer Versorgung von 17 Partialrupturen waren 16 Patienten zufrieden und alle konnten das präoperative Aktivitätslevel wieder erreichen [14]. In einer neuen Übersichtsarbeit wurde über 13 Studien mit 387 operierten Patienten berichtet, wobei keine Studie eine Kontrollgruppe mit konservativer Therapie aufwies [2].…”