Proximal hamstring tendon avulsion: state of the art

Abstract

Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.

Endoscopic Repair of Proximal Hamstring Insertion With Sciatic Nerve Neurolysis

“… 1 , 4 , 5 Most of these injuries are muscle strains of the myotendinous junction. 1 Proximal injuries such as avulsion or avulsion fractures are rare, 6 but these injuries often require surgical fixation. 7 , 8 …”

“…Sports related to proximal hamstring injury mechanism are skiing, dancing, sprinting, and those that require explosive acceleration, as well as sports that combine this with kicking, like soccer. 1 , 6 All the aforementioned activities require hip flexion with the following hamstring eccentric contraction and injury. 1 , 2 , 6 …”

“… 1 , 6 All the aforementioned activities require hip flexion with the following hamstring eccentric contraction and injury. 1 , 2 , 6 …”

“…The hamstring complex is a muscle group that encompasses 3 muscles, the biceps femoris, the semitendinosus, and the semimembranosus. 1 , 6 , 7 , 9 These 3 muscles have a common tendinous origin in the ischial tuberosity, except for the short head of the biceps femoris. 1 , 9 All of them have distinct distal insertions below the knee.…”

“… 1 , 9 All of them have distinct distal insertions below the knee. 1 , 6 , 9 The complex works as a hip extensor and knee flexor. 6 …”