The proximal hamstring muscle–tendon–bone unit: A review of the normal anatomy, biomechanics, and pathophysiology

Beltrán, Luis; Ghazikhanian, Varand; Padrón, Mario; Beltran, Javier

doi:10.1016/j.ejrad.2011.03.099

Cited by 82 publications

(97 citation statements)

References 47 publications

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“…Despite the fact that this subset of hamstring injuries is less common than the myotendinous junction strains, it often results in more debilitating outcomes if left untreated in active patients. 1,12,13 Until recently, proximal hamstring ruptures remained largely unrecognized by treating physicians. In fact, delayed diagnosis of proximal hamstring avulsion has been reported in several studies, showing that patients often consult with various health care professionals, including other orthopaedic surgeons, before receiving appropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

et al. 2012

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Background: The purpose of this study was to assess postsurgical outcomes in active patients after primary repair of acute and chronic proximal hamstring tears. Hypothesis: Surgical treatment of both acute and chronic proximal hamstring avulsion injuries would result in improved patient outcomes using validated outcome scores and a hamstring-specific questionnaire, and operative repair of these injuries results in excellent outcomes with a high level of patient satisfaction, pain relief, and return to function. Study Design: Case series; Level of evidence, 4. Methods: Fifty-two patients who underwent proximal hamstring repair (26 male and 26 female; average age, 47.7 years) completed the Lower Extremity Functional Scale (LEFS), a custom LEFS, the Marx Activity Scale, a custom Marx scale, a proximal hamstring score (which combines the sum of the custom LEFS and Marx), and a proximal hamstring questionnaire with subjective questions. Forty patients were characterized as having acute repairs, and 12 patients had chronic repairs. All patients underwent surgical repair with 5 suture anchors on the ischial tuberosity through a transverse incision. The rehabilitation protocol was also similar with the use of a hip orthosis for 6 to 8 weeks, allowing progressive weightbearing and range of motion. Results: The mean follow-up in our study was 33 months (range, 12-76 months). The mechanism of injury in 28 patients was eccentric hip flexion and knee extension in the ipsilateral knee typically caused by a slip and fall accident. One patient’s injury was caused by trauma to the proximal hamstring. In 23 patients, hamstring injuries were sports related. Overall, 51 (98%) were satisfied with their outcome after surgery. The LEFS, Marx, custom LEFS, custom Marx, and proximal hamstring scores for patients with acute injuries were 76.2, 10.0, 71.4, 20, and 91.7, respectively. For those with chronic injury, the scores were 71.5, 10.4, 70.8, 18.7, and 89.8, respectively. The scores were not statistically different for LEFS, Marx, custom LEFS, and proximal hamstring scores ( P = .22, P = .6, P = .72, and P = .6, respectively). Patients with acute injury did have a greater custom Marx score ( P = .001). Postoperatively, 5 patients (9.6%) had burning pain or numbness in the posterior thigh or foot, and 25 (48%) had at least some discomfort sitting. Thirty-five patients (67%) reported they could participate in strenuous activities at their latest follow-up. All patients estimated their strength recovery at ≥75%. Conclusion: Results of this study indicate successful outcomes for both acute and chronic repairs, although patients with the acute repairs had higher functional and hamstring scores, and estimated hamstring strength.

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Section: Introductionmentioning

confidence: 99%

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

et al. 2012

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“…In this article, SN entrapment neuropathy has been presented. It is however possible that the neuropathy is not derived from SN entrapment, but from compression of the nerve due to SM tendon hypertrophy 1,3 . The two conditions can be concomitant.…”

Section: Strengths and Limitations Of The Techniquementioning

confidence: 99%

“…Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE) therefore represents a possible complication of PHT. Rapid movements of hip flexion and extension or maximum hip flexion can worsen the symptoms, being the SN bound to the hamstring tendon complex (anchoring fibrosis) 1,3,6,8 . However, distinguishing symptoms of tendinopathy from those of neuropathy is fairly complicated.…”

Section: Introductionmentioning

confidence: 99%

Treatment of proximal hamstring tendinopathyrelated sciatic nerve entrapment: presentation of an ultrasound-guided �Intratissue Percutaneous Electrolysis� application

Mattiussi

Moreno

2016

MLTJ

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SummaryBackground: Proximal Hamstring Tendinopathyrelated Sciatic Nerve Entrapment (PHTrSNE) is a neuropathy caused by fibrosis interposed between the semimembranosus tendon and the sciatic nerve, at the level of the ischial tuberosity. Methods: Ultrasound-guided Intratissue Percutaneous Electrolysis (US-guided EPI) involves galvanic current transfer within the treatment target tissue (fibrosis) via a needle 0.30 to 0.33 mm in diameter. The galvanic current in a saline solution instantly develops the chemical process of electrolysis, which in turn induces electrochemical ablation of fibrosis. In this article, the interventional procedure is presented in detail, and both the strengths and limits of the technique are discussed. Results: US-guided EPI eliminates the fibrotic accumulation that causes PHTrSNE, without the semimembranosus tendon or the sciatic nerve being directly involved during the procedure. The technique is however of limited use in cases of compression neuropathy. Conclusion: US-guided EPI is a technique that is quick to perform, minimally invasive and does not force the patient to suspend their activities (work or sports) to make the treatment effective. This, coupled to the fact that the technique is generally well-tolerated by patients, supports use of USguided EPI in the treatment of PHTrSNE.

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“…The biceps femoris tendon and the semitendinosus tendon originate as a conjoint tendon posteromedial to the semimembranosus tendon. Hamstring injuries occur at the weakest link in the bone-tendon-muscle unit: ischial tuberosity bone avulsions in children, myotendinous junction injuries in adolescent and young athletes, and injuries of the tendon itself in older adults (159). In professional soccer players, hamstring muscle strains are the most common single injury subtype and are clinically severe (.28 days lost from playing sports) in 15% of patients (160).…”

Section: Hamstringsmentioning

confidence: 99%

Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. After reading the article and taking the test, the reader will be able to:n Describe biomechanical implications of torsional malalignment and other atypical forms of hip impingement n Describe the most common MR imaging findings in femoroacetabular impingement and identify anatomic variants n Describe imaging characteristics of a Morel-Lavallée lesion and identify the anatomic compartment where this lesion typically occurs n Identify common stress fractures around the hip joint in athletes and discuss potential complications n Describe features of myotendinous injuries around the hip n Describe the anatomic relationship of the sacrotuberous ligament and the origin of the hamstring tendons n Describe the anatomic structures involved in an athletic pubalgia Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure StatementThe ACCME requires that the RSNA, as an accredited prov...

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The proximal hamstring muscle–tendon–bone unit: A review of the normal anatomy, biomechanics, and pathophysiology

Cited by 82 publications

References 47 publications

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

Treatment of proximal hamstring tendinopathyrelated sciatic nerve entrapment: presentation of an ultrasound-guided �Intratissue Percutaneous Electrolysis� application

Hip Imaging in Athletes: Sports Imaging Series

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