Practice patterns for the treatment of acute proximal hamstring ruptures

Pasic, Nicholas; Giffin, J. Robert; Degen, Ryan M.

doi:10.1080/00913847.2019.1645576

Cited by 22 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tendon discontinuity and tendon retraction are important factors for treatment decision making. 12 , 15 Although the development of a reliable MRI assessment is a vital step in the right direction, additional data are needed to assess clinical utility. For one, further validity testing is necessary to investigate whether tendon retraction on MRI correlates with intraoperative findings to ensure accurate preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) plays a pivotal role in both diagnosis and treatment decision making. 2 , 5 , 12 , 15 MRI is considered the gold standard for diagnosis 2 , 5 , 12 because of its superior sensitivity.…”

mentioning

confidence: 99%

“…After a diagnosis, MRI is additionally used for treatment decision making, as identification of involved tendons and assessment of tendon retraction on MRI are widely used as decision modifiers. 12 , 15 Specifically, injuries involving both the conjoint and semimembranosus tendons and retraction of >2 cm are used to support the choice for operative treatment. 15 Additionally, MRI is valuable for preoperative planning.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Good Interrater Reliability for Standardized MRI Assessment of Tendon Discontinuity and Tendon Retraction in Acute Proximal Full-Thickness Hamstring Tendon Injury

et al. 2021

View full text Add to dashboard Cite

Background: Proximal full-thickness free hamstring tendon injury (ie, tendon avulsion or rupture) is a severe injury. Treatment decision making relies on clinical factors and magnetic resonance imaging (MRI) variables; it specifically relies on which tendons are injured as well as the extent of tendon retraction. According to a worldwide evaluation of current practice, discontinuity of both proximal tendons and retraction of >2 cm are used as surgical indications. However, both the diagnosis and the use of MRI variables in decision making may be fraught with uncertainty in clinical practice. A reliable standardized MRI assessment is required. Purpose: To propose an MRI assessment for acute proximal full-thickness free hamstring tendon injury and to evaluate its interater reliability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We included 40 MRI scans of patients with acute (≤4 weeks of injury) proximal full-thickness free hamstring tendon injury. Three musculoskeletal radiologists assessed proximal full-thickness free hamstring tendon discontinuity using the novel “dropped ice cream sign” and tendon retraction (in mm). Quantification of tendon retraction (in mm) was performed using 2 different methods: (1) a direct (ie, shortest distance between the center of the hamstring origin and the tendon stump) method and (2) a combined craniocaudal/mediolateral measurement method. Absolute and relative interrater reliability were calculated. Results: We found an almost perfect interrater agreement (kappa = 0.87) for assessment of full-thickness tendon discontinuity using the dropped ice cream sign. Interrater agreement for the direct and craniocaudal retraction measurements was good for both the conjoint (intraclass correlation coefficient [ICC], 0.88 and 0.83) and the semimembranosus tendons (ICC, 0.81 and 0.79). The mediolateral retraction measurement yielded only moderate to poor reliability for the conjoint (ICC, 0.53) and semimembranosus tendons (ICC, 0.41). Conclusion: The standardized MRI assessment to identify proximal hamstring tendon discontinuity and quantify tendon retraction is reliable. We recommend using the novel dropped ice cream sign and the direct retraction measurement in clinical practice and research.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Good Interrater Reliability for Standardized MRI Assessment of Tendon Discontinuity and Tendon Retraction in Acute Proximal Full-Thickness Hamstring Tendon Injury

et al. 2021

View full text Add to dashboard Cite

show abstract

“…1e4 However, postoperative management is incredibly variable. 5,6 Early rehabilitation strategies concentrated on limitation of hip flexion and knee extension to reduce the strain on the repaired, bi-articular hamstring musculotendinous unit. 3,5e7 This limitation of range of motion was primarily achieved by bracing of the hip, knee or both joints and was awkward and cumbersome.…”

Section: Introductionmentioning

confidence: 99%

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Shilt

McHorse

Moisiuc

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Introduction: Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have been noted and have been attributed to slipping and falling, postoperative muscle spasm, or early mobilization. In a recent review of hamstring repair rehabilitation protocols, it was shown that there is marked variability in post-operative management. Post-operative bracing with limiting knee extension and hip flexion is the standard of care in most early rehabilitation protocols. Braces with limitation of hip flexion and knee locked in 90 0 flexion can be awkward, cumbersome and create fall risk. Chemoprotection has more recently been proposed to be an alternative approach to prevent tendon repair failure and controlled mobilization which has been shown to be superior to complete immobilization. We present the first case series of the use of botulinum toxin for chemo-protection of the proximal hamstring ischial avulsion repair, demonstrating its safety and efficacy. Methods: Retrospective case series at a tertiary children's hospital which included patients <18 years of age who underwent interventional treatment for proximal hamstring avulsion injuries of the ischium utilizing botulinum toxin as a chemoprotective agent. Data collected included demographic data, injury and treatment details, imaging, post-operative rehabilitation and return to activity. Descriptive statistical analysis was conducted. Results: Five male patients with mean age 14 years (12e17) were included in the study. All were sports related non-contact injuries. Radiographs showed displaced avulsion fractures in all 5 patients. All patients had failed conservative management initially; mean time to surgery from initial injury was 34.4 weeks. 4 patients underwent open reduction and internal fixation (ORIF), 1 patient with less displacement had bone marrow aspirate (BMA) injection; all had chemoprotection using botulinum toxin injected in the hamstrings. No patient required hip immobilization or knee immobilization locked to 90 . We elected to use a brace locked at 20 knee flexion in 2/5 patients. All patients underwent supervised physical therapy and achieved symmetric knee range of motion (ROM). Post-operative radiographs confirmed healing of the avulsion fracture in all 5 patients and they all returned to previous level of activity at mean 32 weeks (21e43) from surgery. None of the patients had a hamstring re-injury at mean follow up of 27 months (11e42). Conclusion: Our case series is the first in literature that shows the safety and efficacy of chemoprotection with botulinum toxin for the post-operative management of avulsion injuries of proximal hamstrings, by minimizing the need for cumbersome bracing and allowing controlled motion during physical therapy.

show abstract

“… 1 , 2 , 3 There is a lack of consensus regarding timing and indications for surgery, 1 with several reported indications including avulsion of 2 tendons with more than 2 cm of retraction, complete avulsion of all 3 tendons, displaced bony avulsions, and partial avulsions with persistent pain despite extensive conservative treatment. 4 , 5 It is also important to consider patient factors during surgical consultation, such as age, activity level, functional demands, and expectations. Delayed surgical intervention (>4 weeks) is associated with prolonged morbidity and can be associated with a higher rate of complications owing to the increased technical difficulty required to perform the surgical procedure.…”

mentioning

confidence: 99%

Endoscopic-Assisted Anatomic Reconstruction of Chronic Proximal Hamstring Avulsion With Achilles Allograft

Leininger

Duerr

Chauhan

et al. 2020

Arthroscopy Techniques

View full text Add to dashboard Cite

Hamstring injuries commonly occur at the musculotendinous junction; however, they can occur as proximal avulsion injuries. A lack of recognition can lead to proximal hamstring injuries being frequently misdiagnosed, resulting in delayed treatment. Chronic proximal hamstring tears are often retracted and scarred to the surrounding soft tissues. Owing to the poor quality of tissue at the torn ends of the tendon, an augmented reconstruction using an allograft may be required. In cases with poor visualization of the ischial tuberosity and proximal hamstring footprint, an Achilles tendon allograft can be secured directly to the tuberosity with suture anchors. However, visualization of the footprint can be optimized using an arthroscope. This report describes a technique for endoscopic-assisted anatomic reconstruction using an Achilles allograft with both knotless and knotted suture anchors for chronic complete avulsions of the proximal hamstring.

show abstract

Practice patterns for the treatment of acute proximal hamstring ruptures

Cited by 22 publications

References 29 publications

Good Interrater Reliability for Standardized MRI Assessment of Tendon Discontinuity and Tendon Retraction in Acute Proximal Full-Thickness Hamstring Tendon Injury

Good Interrater Reliability for Standardized MRI Assessment of Tendon Discontinuity and Tendon Retraction in Acute Proximal Full-Thickness Hamstring Tendon Injury

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Endoscopic-Assisted Anatomic Reconstruction of Chronic Proximal Hamstring Avulsion With Achilles Allograft

Contact Info

Product

Resources

About