1
|
Kaila R, French SR, Wood DG. Outcomes following adolescent athlete proximal hamstring apophyseal avulsion bone fragment excision and direct tendon-ischial tuberosity reattachment. J Pediatr Orthop B 2023; 32:278-286. [PMID: 35412512 DOI: 10.1097/bpb.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apophyseal proximal hamstring bone avulsion is uncommon, occurring in adolescents following sudden forceful contraction of the musculotendinous unit. It can be severely disabling, preventing return to sport. This study assessed outcome following avulsed bone excision and direct hamstring tendon-ischial tuberosity reattachment using bone anchors. Validated hamstring-specific Sydney hamstring orthopaedic research evaluation PROMs were prospectively collected from consecutively treated athletes (7 elite and 11 recreational) by a single surgeon over 13 years. Outcomes at 1-year and final follow-up for primary acute surgery at less than 3 months after injury (group 1), primary chronic surgery at more than 3 months after established nonunion (group 2) and revision following failed screw fixation (group 3) were analyzed with sport participation and level at 1 year. Sixteen primary and two revision procedures were analyzed. Mean injury age was 14.6 years (SD, 1.8). Combined primary mean injury scores improved from 11.89 (SD, 7.32) to 33.31 (SD, 2.30) and showed mean 1 year and final follow-up scores within 0.3-6.1% of preinjury values. Pronounced improvement occurred from injured scores for groups 1 versus 2, respectively at 1 year by 247.7% versus 59.0% and at final follow-up by 251.0% versus 64.1%, for groups 1 versus 2, respectively. Final outcome scores of group 3 were high. All cases returned to preinjury sport level by 1 year and indicated satisfaction to repeat treatment. No significant complications occurred. As the largest series to assess outcomes following this surgical technique, success is highlighted by high score improvements close to preinjury values and return to preinjury sport level.
Collapse
Affiliation(s)
- Rajiv Kaila
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Sofie R French
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
| | - David G Wood
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Bilateral Ischial Tuberosity Stress Fractures in an Adolescent Football Player: A Case Report. Clin J Sport Med 2023; 33:e16-e18. [PMID: 36729891 DOI: 10.1097/jsm.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Pelvic stress fractures are rare, making up an estimated 1% to 7% of all stress fractures with the primary locations being the pubic rami, pubic symphysis, and sacrum. Two cases of stress fractures of the ischium have been previously described in the literature, with both occurring in the ischial body. In this case, a 17-year-old high school American football player presented with nonspecific pelvic pain and bilateral point tenderness on deep palpation of the ischial tuberosities. Advanced imaging identified bilateral ischial tuberosity stress fractures. This report outlines the diagnosis and management of the first reported case of bilateral ischial tuberosity stress fractures. We report how ischial tuberosity stress fractures present clinically, potential management strategies, and highlight the use of computed tomography imaging for pelvic stress fractures. Knowledge of unusual stress fracture locations may improve early diagnosis, limit complications, reduce healthcare costs, and promote an accelerated recovery time.
Collapse
|
3
|
Vadhera AS, Knapik DM, Gursoy S, Perry AK, Kunze KN, Singh H, Westrick JC, Chahla J. Avulsion fractures of the ischial tuberosity in the pediatric athlete: a systematic review and return to sport analysis. J Pediatr Orthop B 2022; 31:508-516. [PMID: 35258027 DOI: 10.1097/bpb.0000000000000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apophyseal avulsion fractures of the ischial tuberosity (AFIT) in pediatric athletes are relatively uncommon injuries with treatment and return to sport (RTS) outcomes being largely unknown. The purpose of this review is to perform a systematic review analyzing RTS and predictors of successful RTS for pediatric athletes sustaining AFIT. Studies reporting on athletes strictly under the age of 18 years sustaining an AFIT with reported RTS status were included. RTS was analyzed based on injury acuity, mechanism, and management, whereas the incidence of any complications was recorded. A total of 33 studies comprising 90 cases of AFIT were identified. The mean age of athletes sustaining injuries was 14.7 + 1.4 years (range, 9-17 years), most commonly participating in soccer ( n = 25), sprinting ( n = 21), and gymnastics ( n = 7). Acute trauma during sporting activities was responsible for 74.4% ( n = 77/90) of injuries. A total of 82% ( n = 74/90) of athletes reported successful RTS at an average of 7.0 + 5.0 months. Athletes undergoing surgery had a significantly higher RTS rate ( n = 36/38, 94.7%) compared with athletes treated nonoperatively (n = 38/52, 73.08%; P = 0.008). When reported, a high rate of misdiagnosis was reported (39.4%, n = 28/71). Complications were reported in 15.8% ( n = 7/38) and 32.7% ( n = 17/52) of athletes managed surgically and conservatively, respectively. As such, the high rate of misdiagnosis and subsequent high rate of complications and poor rate of RTS highlight the importance of accurate diagnosis and treatment. Future prospective studies evaluating patient outcomes based on fracture displacement, sporting activity, and management strategies are warranted to better treat pediatric athletes. Study design: Level IV, systematic review.
Collapse
Affiliation(s)
- Amar S Vadhera
- Division of Sports Medicine, Department of Orthopedic Surgery
| | | | - Safa Gursoy
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Allison K Perry
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Kyle N Kunze
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Harsh Singh
- Division of Sports Medicine, Department of Orthopedic Surgery
| | | | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedic Surgery
| |
Collapse
|
4
|
Audenaert EA, Duquesne K, De Roeck J, Mutsvangwa T, Borotikar B, Khanduja V, Claes P. Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation. J Hip Preserv Surg 2021; 7:677-687. [PMID: 34548927 PMCID: PMC8448428 DOI: 10.1093/jhps/hnab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
The risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions. A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large (n = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant (P < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study.
Collapse
Affiliation(s)
- E A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.,Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.,Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Groenenborgerlaan 171, Antwerp 2020, Belgium.,Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - K Duquesne
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - J De Roeck
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - T Mutsvangwa
- Division of Biomedical Engineering, University of Cape Town, Anzio Rd, Observatory, Cape Town 7925, South Africa
| | - B Borotikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Lavale, Mulshi District, Pune 412115, India.,Laboratory of Medical Information Processing (LaTIM), UMR 1101, INSERM, Avenue Foch 12, 29200 Brest, France
| | - V Khanduja
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - P Claes
- Department of Human Genetics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Electrical Engineering, ESAT/PSI, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.,Murdoch Children's Research Institute, Melbourne, Flemington Road, Parkville Victoria 3052, Australia
| |
Collapse
|
5
|
Nauta HJA, van der Made AD, Tol JL, Reurink G, Kerkhoffs GM. Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:1813-1821. [PMID: 32809117 PMCID: PMC8126544 DOI: 10.1007/s00167-020-06222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/06/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery. METHODS A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68-95), return to sports (RTS) rate of 100% (95% CI: 82-100), Harris hip score (HHS) of 99 (range 96-100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68-100), RTS rate of 86% (95% CI: 69-94), HHS score of 99 (range 96-100), and non-union rate of 18% (95% CI: 9-34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21-100], RTS: 100% [95% CI: 51-100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65-95) and 100% (95% CI: 84-100), and 0% (0/1, 95% CI: 0-79) and 100% (95% CI: 51-100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34-100 & 57-100) compared to 100 (95% CI: 72-100) and 90% (95% CI: 60-98) for delayed repair. CONCLUSION All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Hijleke J A Nauta
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Anne D van der Made
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.
| | - Johannes L Tol
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gustaaf Reurink
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Gino M Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J 2020; 102-B:556-567. [PMID: 32349600 DOI: 10.1302/0301-620x.102b5.bjj-2019-1212.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.
Collapse
Affiliation(s)
- Jung Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Seongnam, South Korea
| | - Seunghwan Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seoul National University College of Medicine Seongnam, South Korea
| |
Collapse
|
7
|
Ali AM, Lewis A, Sarraf KM. Surgical treatment of an ischial tuberosity avulsion fracture with delayed presentation. J Clin Orthop Trauma 2020; 11:S4-S6. [PMID: 31992908 PMCID: PMC6978189 DOI: 10.1016/j.jcot.2019.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022] Open
Abstract
Avulsion fractures of the ischial tuberosity usually occur in skeletally immature athletes following eccentric contraction of the hamstrings. When displaced fractures are left untreated, subsequent non-union and proximal hamstring fibrosis may lead to chronic pain and reduced activity. However, the indications for and outcomes of operative fixation when presentation is delayed remain unclear. We report the case of a 14 year old male athlete who presented to our institution 6 weeks after sustaining a displaced ischial tuberosity avulsion fracture. He underwent open reduction and internal fixation using a cannulated screw system via a posterior approach, with excellent results at 18 months follow-up. We report our surgical findings in detail as well as a novel method for post-operatively assessing functional screw head prominence-the seated radiograph.
Collapse
Affiliation(s)
- Adam M. Ali
- Corresponding author. Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London. W2 1NY, UK.
| | | | | |
Collapse
|
8
|
Liu H, Li Q, Shi Y, Zhang Y, Xu K, Qin W, Liu Z, Liu W, Peng B, Dou S, Zhao C, Zhao K, Zhang Q. Surgical treatment for acute ischial tuberosity avulsion fracture: A case report. Medicine (Baltimore) 2019; 98:e15040. [PMID: 30946345 PMCID: PMC6455987 DOI: 10.1097/md.0000000000015040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ischial tuberosity avulsion fracture (ITAF) is a very rare sports injury, and there is currently no consensus on its diagnosis and treatment. Although conservative treatment is adequate for most patients, those with large displacement of the fracture need surgical management. PATIENT CONCERNS A 13-year-old male athlete experienced tearing pain in the right hip during a sprint. Radiographic examination showed an avulsion fracture of the right ischial tuberosity. DIAGNOSIS Right ITAF. INTERVENTIONS On the 3rd day of injury, the patient was treated with open reduction and internal fixation of ITAF under general anesthesia. OUTCOMES The patient received a systematic postoperative exercise in 2 weeks, and the fracture healed 4 weeks later. After 8 months, the patient returned to the field to participate in the competition. LESSONS Early surgical treatment can bring about good results in the treatment of ITAF with large displacement. The longitudinal incision and subgluteal approach is an ideal choice for the operative procedure.
Collapse
Affiliation(s)
- Heng Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Yi Shi
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | | | - Kai Xu
- Department of Radiology, China-Japan Union Hospital of Jilin University
| | - Wenheng Qin
- Department of Radiology, China-Japan Union Hospital of Jilin University
| | - Zhengjun Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Wei Liu
- Department of Orthopedics, Changchun City Orthopedic Hospital, Changchun, Jilin Province, China
| | - Bo Peng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Shilu Dou
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Changfu Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Kunchi Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Qiao Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| |
Collapse
|
9
|
Avulsion fracture of the ischial tuberosity treated with the suture bridge technique: a case report. BMC Musculoskelet Disord 2019; 20:9. [PMID: 30611250 PMCID: PMC6320617 DOI: 10.1186/s12891-018-2377-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background In cases of avulsion fracture of the ischial tuberosity in which the bone fragments are substantially displaced, nonunion may cause pain in the ischial area. Various surgical procedures have been reported, but achieving sufficient fixation strength is difficult. Case presentation We treated a 12-year-old male track-and-field athlete with avulsion fracture of the ischial tuberosity by suture anchor fixation using the suture bridge technique. The boy felt pain in the left gluteal area while running. Radiography showed a left avulsion fracture of the ischial tuberosity with approximately 20-mm displacement. Union was not achieved by conservative non-weight-bearing therapy, and muscle weakness persisted; therefore, surgery was performed. A subgluteal approach was taken via a longitudinal incision in the buttocks, and the avulsed fragment was fixed with five biodegradable suture anchors using the suture bridge technique. Conclusions Although the majority of avulsion fractures of the ischial tuberosity can be treated conservatively, patients with excessive displacement require surgical treatment. The suture bridge technique provided secure fixation and enabled an early return to sports activities.
Collapse
|
10
|
Liu H, Zhang Y, Rang M, Li Q, Jiang Z, Xia J, Zhang M, Gu X, Zhao C. Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment. Med Sci Monit 2018; 24:9406-9412. [PMID: 30589058 PMCID: PMC6322373 DOI: 10.12659/msm.913799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative treatment appears to be the predominate choice. Furthermore, the degree of fracture displacement (DFD) remains as an important factor in determining whether AFIT needs internal fixation. The aim of the present study was to review and update the injury mechanism, clinical manifestations, imaging examination, diagnosis and differential diagnosis, and treatment of AFIT. A literature search was performed on a variety of databases using text words, and the results were limited to the English language. This review provides an important reference for the diagnosis and treatment of AFIT. AFIT can be easily misdiagnosed. Therefore, a detailed medical history and imaging examination are crucial for a correct diagnosis and differential diagnosis. For the choice of treatment of AFIT, it is necessary to consider not only the size of the fracture and DFD, but also the long-term functional needs of the patient.
Collapse
Affiliation(s)
- Heng Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yiqun Zhang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Moujie Rang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Zhaowei Jiang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jidong Xia
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Mingyi Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Xuan Gu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Changfu Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| |
Collapse
|
11
|
Tyberghein M, Kaux J, Godon B, Crielaard J, Croisier J. Avulsion fracture of the ischial tuberosity in a young sprinter: Functional versus radiological assessment. ISOKINET EXERC SCI 2018. [DOI: 10.3233/ies-182107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M. Tyberghein
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium
| | - J.F. Kaux
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium
- Department of Sports and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - B. Godon
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium
| | - J.M. Crielaard
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium
- Department of Sports and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - J.L. Croisier
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium
- Department of Sports and Rehabilitation Sciences, University of Liège, Liège, Belgium
| |
Collapse
|
12
|
Spencer-Gardner L, Bedi A, Stuart MJ, Larson CM, Kelly BT, Krych AJ. Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion. Knee Surg Sports Traumatol Arthrosc 2017; 25:55-61. [PMID: 26429568 DOI: 10.1007/s00167-015-3812-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. METHODS All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). RESULTS Ten patients with a mean age of 18 years (range 14-28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7-3.5), the median post-operative mHHS was 89.7 (65.7-96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. CONCLUSION Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Asheesh Bedi
- Medsport Clinic University of Michigan, 24 Frank Lloyd Wright Dr Ste 1000, Ann Arbor, MI, 48105, USA
| | | | | | - Bryan T Kelly
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Aaron J Krych
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA.
| |
Collapse
|
13
|
The Exceptionality of the Young Athlete. CONTEMPORARY PEDIATRIC AND ADOLESCENT SPORTS MEDICINE 2016. [DOI: 10.1007/978-3-319-18141-7_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|
14
|
Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23:2449-2456. [PMID: 24556933 DOI: 10.1007/s00167-014-2912-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 02/09/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Hamstring injuries are among the most common muscle injuries seen in sports clinical practice. This narrative review covers essential knowledge of hamstring injuries, ranging from strains to total proximal three-tendon ruptures. The primary aim is to provide basic information for clinicians and sports medicine therapists dealing with hamstring problems. METHODS In this review, existing literature of hamstring injuries was taken together. Emphasis was given to subjects less well covered in previous reviews, such as preventive measures, as well as the most relevant information needed in the treatment of these injuries. RESULTS Occasionally, symptoms remain after hamstring injuries which can be successfully treated with surgery. Knowledge of the effectiveness of preventive measures and nonsurgical and surgical treatment is limited by small studies of low evidence level. CONCLUSIONS Evidence-based treatment algorithms are not available. Larger studies of better quality with more concrete grading of hamstring tears are needed to improve knowledge in prevention and treatment of hamstring injuries. LEVEL OF EVIDENCE IV.
Collapse
|
15
|
Abstract
OBJECTIVE Complete traumatic avulsion of the ischial tuberosity in young athletes is rare, and the optimal treatment is unclear. The purpose of this article is to present our experience and the efficacy of surgical repair of avulsions of the ischial tuberosity with bony dislocation of more than 2 cm and to discuss the complex postoperative rehabilitation. METHODS Three young athletes sustained complete avulsion of the ischial tuberosity with bony dislocation during different sport activities (long jump, soccer, sprinting). The age at the time of injury ranged from 13.8 to 15 years. All underwent surgical repair with reattachment of the hamstring muscle complex to the origin on the ischium. The time from injury to repair varied from 2 to 22 weeks. All patients underwent a specific postoperative rehabilitation program. Follow-up ranged from 12 to 24 months. RESULTS All athletes had improved with surgery and had good subjective and objective functional results. One patient needed operative revision 1 day after primary repair because of suture loosening because of excessive muscle contractions during wake up after general anesthesia. Finally, all returned to their preinjury sport at the same level. CONCLUSIONS Young athletes with traumatic avulsion of the ischial tuberosity and dislocation of more than 2 cm benefit from operative repair. Good results were achieved in all cases on the basis of functional recovery and patient satisfaction. Chronic complaints could be avoided, and also return to sport was possible. Surgery under spinal anesthesia is recommended.
Collapse
|
16
|
Ferlic PW, Sadoghi P, Singer G, Kraus T, Eberl R. Treatment for ischial tuberosity avulsion fractures in adolescent athletes. Knee Surg Sports Traumatol Arthrosc 2014; 22:893-7. [PMID: 23793970 DOI: 10.1007/s00167-013-2570-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 06/10/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Avulsion fractures of the ischial tuberosity are rare sports injuries typically occurring in young athletes. Their misdiagnosis may lead to chronic pain or disability. The aim of this study is to report a retrospective series of patients sustaining a fracture of the ischial tuberosity and to propose decision guidelines. METHODS The mechanism of accident, the diagnostic management, the mode of treatment and outcome after avulsion fractures of the ischial tuberosity in adolescents were analysed. RESULTS Thirteen patients (1 female and 12 males) with a median age of 15 years (range 13-16 years) with an avulsion fracture of the ischial tuberosity were included. Twelve of these patients suffered from sports injuries leading to the avulsion fracture. Five of our patients with a displacement of >15 mm were treated operatively. The outcome was excellent in cases of acute presentation and osteosynthesis. Eight patients were treated conservatively: four of them showed a displacement of <15 mm and had an excellent outcome; and the other four patients had a displacement of >15 mm. Two of those patients had excellent outcome with regular bone healing, the remaining two patients developed pseudarthrosis associated with a good outcome. CONCLUSION The present paper shows that in patients with displacement of <15 mm, conservative treatment yields excellent results and early operative intervention should be considered in physically active patients with displacement of >15 mm.
Collapse
Affiliation(s)
- Peter W Ferlic
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND Avulsion injury of the hamstring muscles from their origin on the ischium is an uncommon injury. In persons aged 14 to 25 years, such an avulsion may include detachment of an epiphyseal fragment at the growth plate of the ischial apophysis. The literature suggests that surgery is not necessary unless there is a large displacement of the fragment. The objective of this report is to present evidence that treatment planning should be based on symptoms, regardless of displacement. METHODS Between July 1998 and July 2002, 3 consecutive patients with avulsion of the immature ischial apophysis were evaluated by the senior author. In each case the bony fragment was excised and the hamstrings were reattached to the ischium with suture anchors. All patients were assessed postoperatively by biodex strength testing. RESULTS The average age of the patients was 15 years and the average time to repair was 7 months from the time of injury. The average retraction was 3.7 cm. The average follow-up period was 78 months. The average strength was 86% and the average power was 100% compared with the contralateral side at the final follow-up. In all 3 cases pain was relieved, and with adequate rehabilitation normal strength was regained and the subjects returned to sport. There was one complication involving an activity-related peroneal nerve palsy. This was treated by neurolysis with good functional return. CONCLUSIONS The 3 cases presented here suggest that treatment should be planned on the basis of pain and disability rather than pathology, and that surgical treatment can effectively address a chronic condition. Each case requires an individualized treatment plan and should include a consideration of the patient's functional goals.
Collapse
|
18
|
Pedret C, Balius R, Barceló P, Miguel M, Lluís A, Valle X, Gougoulias N, Malliaropoulos N, Maffulli N. Isolated tears of the gracilis muscle. Am J Sports Med 2011; 39:1077-80. [PMID: 21335356 DOI: 10.1177/0363546510394436] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. PURPOSE To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. STUDY DESIGN Case series; Level of evidence, 4. METHODS This is a retrospective review of 7 elite athletes with posterior thigh pain (3 dancers, 2 soccer players, 1 tae kwon do player, 1 tennis player). In all athletes, the injury occurred during thigh adduction with the hip internally rotated, as clearly evident at ultrasound scans performed 1 to 20 days after the injury. Management included an initial rest period, followed by physiotherapy and gradual return to sports activities. RESULTS According to the ultrasound scans, the lesions were in the proximal-middle third junction of the thigh, at the muscle-tendon junction. The lesions were classified as grade 2 (partial discontinuity). The muscle injury area was, on average, 17.1 × 23.7 mm (range, 10-31 × 9-46 mm). The average length of the lesions was 40.14 mm (range, 20-52 mm). All athletes recovered and returned to full performance within 6 weeks of the injury (average, 35.6 days). CONCLUSION Medial thigh pain after eccentric contraction during hip adduction should raise suspicion of a gracilis muscle tear. Ultrasound is useful, and full recovery occurs within 6 weeks from the injury.
Collapse
Affiliation(s)
- Carles Pedret
- Centre de Diagnòstic per Imatge de Tarragona, Tarragona, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Apophysitis of the posterior superior iliac spine associated with lumbar spondylolysis in a high school athlete. PM R 2011; 3:387-90. [PMID: 21497326 DOI: 10.1016/j.pmrj.2010.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 11/27/2010] [Accepted: 12/10/2010] [Indexed: 11/22/2022]
|
20
|
Steinbrueck A, Hocke S, Heimkes B. Apophyseolysis of the greater trochanter through excessive sports: a case report. Am J Sports Med 2011; 39:195-8. [PMID: 20929938 DOI: 10.1177/0363546510382209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Arnd Steinbrueck
- Department of Orthopedic Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University Munich, Germany
| | | | | |
Collapse
|
21
|
Malliaropoulos N, Papacostas E, Kiritsi O, Papalada A, Gougoulias N, Maffulli N, Maffulli N. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 2010; 38:1813-9. [PMID: 20522825 DOI: 10.1177/0363546510366423] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value. HYPOTHESIS Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS One hundred sixty-five track and field athletes with acute, first-time, unilateral posterior thigh muscle injuries were prospectively evaluated regarding knee active range of motion deficit. This was compared with the uninjured side 48 hours after injury. A control group was also examined. Ultrasound was used to image the muscle lesion. All athletes were managed nonoperatively with the same rehabilitation protocol. The "full rehabilitation time" (interval from the injury to full athletic activities) was recorded. RESULTS Range of motion of the affected leg was decreased in the 165 injured athletes compared with the uninjured side and the control group. Sonography identified abnormalities in 55% (90 of 165) of the injured athletes. The biceps femoris was the most commonly affected muscle (68 of 90 [75%]). The musculotendinous junction (proximal or distal) was involved in 93% (85 of 90) of lesions. Eighty-one percent (133 of 165) of athletes had active range of motion deficit of less than 20 degrees, and had returned to full performance at 2 weeks. In 6 of 165 athletes (3.6%), with active range of motion deficit of more than 30 degrees, recovery time exceeded 6 weeks, with a significant correlation between full rehabilitation time and active range of motion deficit (chi(2) = 152.560; P = .0001). CONCLUSION Knee active range of motion deficit is an objective and accurate measurement, predicting recovery time in elite athletes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nicola Maffulli
- Centre of Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry Mile End Hospital, London, United Kingdom
| |
Collapse
|
22
|
Abstract
Hamstring injuries in sport can be debilitating. The anatomical complexity of this muscle makes uniform assessment of injury epidemiology difficult and insures that post-injury management strategies must be individually focused. This article reviews the anatomy of the hamstring, its role in athletic movement, common mechanisms of injury, and management guidelines with the goal of return into sporting activity in mind.
Collapse
Affiliation(s)
- Chad Carlson
- Stadia Sports Medicine, 6000 University Avenue, Suite 250, West Des Moines, IA 50266, USA.
| |
Collapse
|
23
|
Abstract
The aim of this article is to emphasize the importance of MR imaging in the evaluation of chronic hip pain and overuse injuries. Image interpretation of the hip can be difficult because of the complex anatomy and the varied pathology that athletes can present with, such as labral and cartilaginous injuries, surrounding soft tissue derangement involving muscles or tendons, and osseous abnormalities. The differential diagnosis in adults is diverse and includes such common entities as stress fracture, avulsive injuries, snapping-hip syndrome, iliopsoas bursitis, femoroacetabular impingement syndrome, tendinosis, and tears of the gluteal musculature.
Collapse
|
24
|
Sarimo J, Lempainen L, Mattila K, Orava S. Proximal 1- and 2-Tendon Hamstring Avulsions: Overview and Surgical Technique. OPER TECHN SPORT MED 2009. [DOI: 10.1053/j.otsm.2009.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Abstract
CONTEXT Overuse injuries of the musculoskeletal system in immature athletes are commonly seen in medical practice. EVIDENCE ACQUISITION An analysis of published clinical, outcome, and biomechanical studies of adolescent epiphyseal and overuse injuries was performed through 2008 to increase recognition and provide treatment recommendations. RESULTS Adolescent athletes can sustain physeal and bony stress injuries. Recovery and return to play occur more swiftly if such injuries are diagnosed early and immobilized until the patient is pain-free, typically about 4 weeks for apophyseal and epiphyseal overuse injuries. Certain epiphyseal injuries have prolonged symptoms with delayed treatment, including those involving the bones in the hand, elbow, and foot. If such injuries are missed, prolonged healing and significant restrictions in athletic pursuits may occur. CONCLUSION Some of these injuries are common to all weightbearing sports and are therefore widely recognized. Several are common in gymnastics but are rarely seen in other athletes. Early recognition and treatment of these conditions lead to quicker recovery and so may prevent season-ending, even career-ending, events from occurring.
Collapse
Affiliation(s)
- Todd J. Frush
- Address correspondence to Todd J. Frush, MD, Cincinnati SportsMedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242 (e-mail: )
| | | |
Collapse
|
26
|
Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009; 37:727-34. [PMID: 19218559 DOI: 10.1177/0363546508330129] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tendon disorders are common problems in sports and are known to be difficult to treat. Only limited information is available concerning treatment of proximal hamstring tendinopathy. To the authors' knowledge, no histopathologic findings of proximal hamstring tendinosis have been published. HYPOTHESIS Surgery (semimembranosus tenotomy and exploration of the sciatic nerve) is an effective treatment for proximal hamstring tendinopathy. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 103 cases of proximal hamstring tendinopathy in athletes (58 men, 32 women; 13 bilateral operations) with surgical treatment were included. The cases were retrospectively analyzed, and a 4-category rating system was used to evaluate the overall result. At the follow-up, the patients were asked about possible symptoms and their return to sports. Biopsy samples from 15 of the operated tendons were taken and analyzed by a pathologist. RESULTS The average follow-up was 49 months (range, 12-156 months). The result was evaluated to be excellent in 62 cases, good in 30, fair in 5, and poor in 6. After surgery, 80 of the 90 patients were able to return to the same level of sporting activity as before the onset of the symptoms. This took a mean of 5 months (range, 2-12 months). Typical morphologic findings of tendinosis were found in all biopsy specimens. CONCLUSION Given the good functional outcome and low complication rate, the authors present surgical treatment as a valuable option in proximal hamstring tendinopathy if conservative treatment fails.
Collapse
Affiliation(s)
- Lasse Lempainen
- Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland.
| | | | | | | | | |
Collapse
|
27
|
Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med 2008; 36:1799-804. [PMID: 18448581 DOI: 10.1177/0363546508315892] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring strains can be of at least 2 types, 1 occurring during high-speed running and the other during motions in which the hamstring muscles reach extreme lengths, as documented for sprinters and dancers. HYPOTHESIS Hamstring strains in different sports, with similar injury situations to dancers, also show similarities in symptoms, injury location, and recovery time. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Thirty subjects from 21 different sports were prospectively included. All subjects were examined clinically and with magnetic resonance imaging (MRI). The follow-up period lasted until the subjects returned to or finished their sport activity. RESULTS All injuries occurred during movements reaching a position with combined extensive hip flexion and knee extension. They were located proximally in the posterior thigh, close to the ischial tuberosity. The injuries were often complex, but 83% involved the semimembranosus and its proximal free tendon. Fourteen subjects (47%) decided to end their sports activity. For the remaining 16 subjects, the median time for return to sport was 31 weeks (range, 9-104). There were no significant correlations between specific clinical or MRI parameters and time to return to sport. CONCLUSIONS In different sports, an injury situation in which the hamstring muscles reach extensive length causes a specific injury to the proximal posterior thigh, earlier described in dancers. Because of the prolonged recovery time associated with this type of injury, correct diagnosis, based on history and palpation, and adequate information to the subject are essential.
Collapse
Affiliation(s)
- Carl M Askling
- Swedish School of Sport and Health Sciences, Stockholm, Sweden.
| | | | | | | |
Collapse
|
28
|
Bussières AE, Taylor JA, Peterson C. Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach. J Manipulative Physiol Ther 2007; 30:684-717. [DOI: 10.1016/j.jmpt.2007.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/12/2007] [Accepted: 10/14/2007] [Indexed: 12/26/2022]
|
29
|
Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med 2007; 35:1716-24. [PMID: 17567821 DOI: 10.1177/0363546507303563] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises. HYPOTHESIS A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time. STUDY DESIGN Case series (prognosis); Level of evidence, 2. METHODS Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. RESULTS All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semimembranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30-76 weeks). CONCLUSION Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.
Collapse
Affiliation(s)
- Carl M Askling
- Swedish School of Sport and Health Sciences, Stockholm, Sweden.
| | | | | | | |
Collapse
|
30
|
Mayrand N, Fortin J, Descarreaux M, Normand MC. Diagnosis and management of posttraumatic piriformis syndrome: a case study. J Manipulative Physiol Ther 2006; 29:486-91. [PMID: 16904496 DOI: 10.1016/j.jmpt.2006.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 08/16/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study is to describe the clinical management of a young male patient with sciatica symptoms that developed after an avulsion of the ischial tuberosity. This is a rare injury, but complications may occur. CLINICAL FEATURE A 19-year-old patient developed sciatica 6 months after a football injury. The patient described his symptoms as a shooting pain from the buttock to the lateral part of the foot, along the back of his thigh and calf, sometimes accompanied by paresthesia. Physical examination showed restricted hip range of motion and a positive Bonnet's test. X-ray analysis revealed a bony overgrowth of the right ischial tuberosity. INTERVENTION AND OUTCOME A treatment plan was designed to decrease the pain level, increase sacroiliac and lumbar joint mobility, and augment muscular extensibility. The patient received 20 treatments over a period of approximately 3 months. Complete recovery was observed 5 months later. CONCLUSION Although many differential diagnoses were contemplated, it is most likely that changes in muscular tension and gait pattern, resulting from the ischial tuberosity avulsion, contributed to overuse of the piriformis muscle leading to a piriformis syndrome.
Collapse
Affiliation(s)
- Nancy Mayrand
- Département de Chiropratique, Université du Québec à Trois-Rivières, Québec, Canada
| | | | | | | |
Collapse
|
31
|
Kaneyama S, Yoshida K, Matsushima S, Wakami T, Tsunoda M, Doita M. A surgical approach for an avulsion fracture of the ischial tuberosity: a case report. J Orthop Trauma 2006; 20:363-5. [PMID: 16766942 DOI: 10.1097/00005131-200605000-00012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of an avulsion fracture of the ischial tuberosity treated with a new surgical approach early after injury. Although surgical treatment of this fracture is usually avoided because of the difficulty of the procedure and the risk of sciatic nerve complication, we believe our subgluteal approach is simple and safe. We therefore recommend it for treating avulsion fractures of the ischial tuberosity, especially when the fragment is displaced by >2 cm and the sciatic nerve is not involved. If there is clinical evidence of sciatic nerve disturbance, it is likewise an indication for surgery. However, the incision needs to be deepened to approach the nerve, along the lines of the incisions advocated by both Miller and Spinner.
Collapse
Affiliation(s)
- Shuichi Kaneyama
- Department of Orthopaedic Surgery, Akashi Medical Center Hospital, Akashi, Japan.
| | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Abstract
Sports injuries to the hip and groin region have been noted in 5% to 9% of high school athletes. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations and decelerations, and sudden directional changes.Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. Although this article deals mainly with athletic etiologies, the physician must keep in mind that many other medical conditions may also affect the groin. Because of these overlapping medical conditions and because the anatomy of the region is so complex, a team approach is optimal. In Part 1 of this two-part series, ligament/muscle strains, nerve entrapment syndromes, and posterior abdominal wall abnormalities are reviewed as common causes of groin pain.
Collapse
Affiliation(s)
- Vincent Morelli
- Primary Care Sports Medicine Fellowship, Louisiana State University Health Sciences Center, 200 West Esplanade Avenue, Suite 412, Kenner, LA 70065, USA.
| | | |
Collapse
|
34
|
|
35
|
Abstract
Running has steadily gained in worldwide popularity and is the primary exercise modality for many individuals of all ages. Its low cost, versatility, convenience and related health benefits appeal to men and women of broad cultural, ethnic and economic backgrounds. With more children and adults participating in recreational and competitive running, the incidence of injuries has steadily increased. Most running-related injuries affecting the lower extremities are due to preventable training errors, and some may necessitate medical evaluation or a significant reduction in training. Hip injuries in runners are due to interactions of intrinsic and extrinsic factors that adversely affect the complex regional anatomy. Acute or chronic hip pain presents a diagnostic and therapeutic challenge because the vague, nonspecific symptoms and signs may originate from local, regional or distant foci. Muscle strains and tendonitis are the most common aetiologies of hip pain and typically result from sudden acceleration/deceleration manoeuvres, direction changes or eccentric contractions. Apophysitis and avulsion fractures may affect younger runners and produce localised pain at muscle attachment sites. Iliotibial band syndrome is a common cause of lateral hip and knee symptoms characterised by sharp or burning pain that is exacerbated by activity. Bursitis, due to repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursae. Hip osteoarthritis may also produce persistent pain that worsens with running. Stress fractures are potentially serious conditions that affect women more frequently than men. Snapping hip syndrome is a benign condition that results from tight connective tissues' passing repeatedly over the greater trochanter, anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence. Acetabular labral tears, sports hernias and nerve entrapment syndromes are also potential causes of persistent hip pain in runners. Treatment of hip pain in running should focus not only on addressing the symptoms but also identifying the underlying conditions that precipitated the injury. Injury prevention and comprehensive rehabilitation are essential, since prior hip injuries increase the risk of subsequent ones. Coaches, trainers and medical personal who care for runners should advocate running regimens, surfaces, shoes, technique and individualised conditioning programmes that minimise the risk of initial or recurrent hip injuries.
Collapse
Affiliation(s)
- Scott A Paluska
- Department of Family Medicine, University of Illinois, Urbana, Illinois, USA.
| |
Collapse
|
36
|
Yamamoto T, Akisue T, Nakatani T, Kawamoto T, Hitora T, Marui T, Kurosaka M. Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging. Skeletal Radiol 2004; 33:737-40. [PMID: 15205927 DOI: 10.1007/s00256-004-0806-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 04/21/2004] [Accepted: 04/21/2004] [Indexed: 02/02/2023]
Abstract
We present multimodality imaging features of an ischial tuberosity apophysitis in a 13-year-old boy who was an active baseball pitcher. Roentgenography of the pelvis and computed tomography showed mild irregularity in the inferior margin of the left ischial tuberosity. T1-weighted MRI showed a wide area with low signal intensity in the left ischial body; T2-weighted fat-suppression images showed areas with markedly high signal intensity in the ischial apophysis and body and the surrounding periosteum; contrast-enhanced T1-weighted fat-suppression MRI showed that the ischial body, surrounding periosteum, and origin of the hamstring muscles strongly enhanced; technetium-99m scintigraphic scans showed increased isotope uptake in the entire ischial body. Histological specimens obtained from the bone showed increased osteoblastic activity, edema, and proliferation of benign spindle cells and small vessels in the bone marrow spaces. In the present case, because MR imaging demonstrated extensive signal abnormalities involving the apophysis, periosteum, and intramedullary portion of bone, a neoplasm could not be excluded, and a biopsy was undertaken.
Collapse
Affiliation(s)
- Tetsuji Yamamoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, 650-0017 Kobe, Japan.
| | | | | | | | | | | | | |
Collapse
|
37
|
Holmstrom MC, Greis PE, Horwitz DS. Chronic ischial apophysitis in a gymnast treated with transapophyseal drilling to effect "apophysiodesis". A case report. Am J Sports Med 2003; 31:294-6. [PMID: 12642268 DOI: 10.1177/03635465030310022301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
38
|
Affiliation(s)
- Jonathan A Drezner
- Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, 19104, USA.
| |
Collapse
|
39
|
Berthelot JM, Varin S, Caillon F, Prost A, Maugars Y. Pseudomonas aeruginosa osteomyelitis of both ischia: a case report. J Bone Joint Surg Am 2002; 84:441-4. [PMID: 11886916 DOI: 10.2106/00004623-200203000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
40
|
Abstract
Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called "sports hernia." There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.
Collapse
Affiliation(s)
- K Anderson
- Center for Athletic Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA
| | | | | |
Collapse
|
41
|
Abstract
Injuries to the hip and pelvis make up a small but significant proportion of painful conditions in runners. Most of these injuries are due to overuse and some, such as femoral neck stress fracture, may involve significant morbidity. Apophyseal injuries are becoming more prevalent and should be considered in the skeletally immature athlete. Stress fractures and soft-tissue injuries occur in all age-groups, often because of excessive mechanical stress without adequate recovery periods. A systematic approach to evaluation and treatment-combined with knowledge of indications for surgical referral, training principles, and shoe-wear patterns-allows the physician to individualize the athlete's rehabilitation and return to running, and to help the athlete prevent re-injury.
Collapse
Affiliation(s)
- K H Browning
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
42
|
Van der Wall H, Storey G, Frater C, Murray P. Importance of positioning and technical factors in anatomic localization of sporting injuries in scintigraphic imaging. Semin Nucl Med 2001; 31:17-27. [PMID: 11200202 DOI: 10.1053/snuc.2001.18740] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sports medicine is becoming increasingly important as more people take up exercise for health and well-being. It is adding to the spectrum of acute and chronic injuries that have traditionally been seen in elite or professional athletes. Because of its high sensitivity and lesion contrast, bone scintigraphy has traditionally played a key role in the detection of such injuries. This role has been reduced in recent times by the increased use of magnetic resonance imaging (MRI), which has functional capability, high-contrast resolution, and high-spatial resolution. Bone scintigraphy has the capability of detecting early cortical ligament avulsion and enthesopathic disease before the onset of edema or changes in bone marrow that are detected by MRI. If this capability is added to more precise anatomic localization of lesions, we may see a resurgence in its use in sports medicine. A number of techniques are presented in this article, encompassing positioning, special views, and tomographic reconstructions, that can significantly improve the accuracy of localization of scintigraphic abnormalities with reference to anatomic models or sources of cross-sectional anatomy.
Collapse
Affiliation(s)
- H Van der Wall
- Department of Nuclear Medicine, Concord Hospital, Australia
| | | | | | | |
Collapse
|
43
|
Reeves RK, Laskowski ER, Smith J. Weight training injuries: part 1: diagnosing and managing acute conditions. PHYSICIAN SPORTSMED 1998; 26:67-96. [PMID: 20086781 DOI: 10.3810/psm.1998.02.939] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When patients present with acute weight training injuries, familiarity with the demands of the activity can help physicians get the most out of the patient history. Probable risk factors for injury include errors in technique (described in a sidebar), skeletal immaturity, and anabolic steroid abuse. Common acute injuries in weight training include sprains, strains, tendon avulsions, and compartment syndrome. Possible nonmusculoskeletal problems include retinal hemorrhage, radiculopathy, and various cardiovascular complications. Treatment of acute musculoskeletal injuries varies, but usually includes sports medicine mainstays such as prompt RICE. Chronic weight training injuries will be described in part 2 of this series.
Collapse
Affiliation(s)
- R K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | |
Collapse
|