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Jokela A, Valle X, Kosola J, Rodas G, Til L, Burova M, Pleshkov P, Andersson H, Pasta G, Manetti P, Lupón G, Pruna R, García-Romero-Pérez A, Lempainen L. Mechanisms of Hamstring Injury in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings. Clin J Sport Med 2023; 33:217-224. [PMID: 36730099 PMCID: PMC10128906 DOI: 10.1097/jsm.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis. DESIGN Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022. SETTING Two specialized sports medicine hospitals. PARTICIPANTS Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI. INDEPENDENT VARIABLES Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings. MAIN OUTCOME MEASURES Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location. RESULTS Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretch-type (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion <45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries. CONCLUSIONS According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.
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Affiliation(s)
- Aleksi Jokela
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Xavier Valle
- FC Barcelona, Medical Department, Barcelona, Spain
- Department de Cirurgia de la Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jussi Kosola
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland;
| | - Gil Rodas
- FC Barcelona, Medical Department, Barcelona, Spain
| | - Lluís Til
- Human Performance Department SL Benfica, Lisbon, Portugal
| | | | | | | | | | | | | | - Ricard Pruna
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Alvaro García-Romero-Pérez
- Watford FC, Injury Prevention and Rehabilitation Department, Watford, United Kingdom
- Physiotherapy Department, Universidad Camilo José Cela, Madrid, Spain; and
| | - Lasse Lempainen
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland;
- FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland and Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland.
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Bohyn C, Chaudhary SR, Cresswell M. Posttraumatic cicatricial sciatic nerve entrapment: dynamic imaging and percutaneous neurolysis. Skeletal Radiol 2022; 51:1889-1897. [PMID: 35169938 DOI: 10.1007/s00256-022-04015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
We describe a case of late-onset sciatic neuralgia due to cicatricial tethering of the sciatic nerve by a retracted torn hamstring muscle that was successfully treated with percutaneous neurolysis. Ultrasound and MRI showed a chronic complete avulsion of the proximal hamstring complex with fatty atrophy of the retracted hamstring muscles. Dynamic ultrasound and magnetic resonance imaging displayed tethering of the retracted hamstring complex to the sciatic nerve caused by cicatricial adhesions. Whereas hamstring injuries are highly prevalent sports injuries, there are only a small number of reported cases in the literature of late-onset sciatic nerve involvement. We highlight the benefits of dynamic ultrasound and magnetic resonance imaging and propose ultrasound-guided percutaneous neurolysis as a viable minimally invasive treatment option.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada.
- Department of Radiology, AZ Monica, Antwerp, Belgium.
| | | | - Mark Cresswell
- Department of Radiology, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada
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Monitoring of Eccentric Hamstring Strength and Eccentric Derived Strength Ratios in Judokas from a Single Weight Category. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010604. [PMID: 35010858 PMCID: PMC8744727 DOI: 10.3390/ijerph19010604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
Background: This study was designed to perform isokinetic knee testing of male judokas competing in the under 73 kg category. The main aims were: to establish the concentric (CON) and eccentric (ECC) strength profile of hamstrings (H) and CON profile of quadriceps (Q) muscles; to evaluate the differences in CON and ECC peak torques (PT) with various strength ratios and their bilateral asymmetries; the calculation of the dynamic control ratio (DCR) and H ECC to CON ratio (HEC); Methods: 12 judokas competing on a national and international levels with a mean age of 19 ± 4 years, a weight of 75 ± 2 kg and with a height of 176 ± 5 cm were tested. All the subjects were right-hand dominant. Isokinetic testing was performed on iMOMENT, SMM isokinetic machine (SMM, Maribor, Slovenia). The paired t-test was used to determine the difference between paired variables. The level of significance was set at p ≤ 0.05; Results: Statistical differences between left (L) and right (R) Q PT (L 266; R 241 Nm), H ECC PT (L 145; R 169 Nm), HQR (L 0.54; R 0.63), DCR (L 0.55; R 0.70), HEC (L 1.02; R 1.14) and PTQ/BW (L 3.57; R 3.23 Nm/kg) were shown. Bilateral strength asymmetries in CON contraction of 13.52% ± 10.04 % for Q, 10.86% ± 7.67 % for H and 22.04% ± 12.13% for H ECC contraction were shown. Conclusions: This study reports the isokinetic strength values of judokas in the under 73 kg category, emphasising eccentric hamstring strength and eccentric derived strength ratios DCR and HEC. It was shown that asymmetries are better detected using eccentric testing and that the dominant leg in judokas had stronger eccentric hamstring strength resulting in higher DCR and HEC.
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Fouasson-Chailloux A, Menu P, Mesland O, Dauty M. Strength assessment after proximal hamstring rupture: A critical review and analysis. Clin Biomech (Bristol, Avon) 2020; 72:44-51. [PMID: 31812036 DOI: 10.1016/j.clinbiomech.2019.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/26/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Muscular strength should be one of the main parameters to assess the interest or not of surgery after proximal hamstring rupture. Yet, this parameter is difficult to compare between the different studies because of the heterogeneous assessment methods. METHODS We realized a critical review of strength assessment methods used to evaluate treatments performed after proximal hamstring rupture. The studies were selected from several medical databases with the keywords: "proximal hamstring rupture" OR "proximal hamstring avulsion" AND "strength" OR "isokinetic". FINDINGS 24 articles evaluated muscular strength after proximal hamstring rupture. 7 have been excluded because the method was not described. 6 types of dynamometric evaluation were used: 2 with an isometric method, 3 with a pneumatic isotonic method and 13 with an isokinetic method. Muscular strengths after non-surgical treatment could not be compared because of the low number of studies and different methods of assessment. After surgery, only isokinetic results measured at the angular speed of 60°/s could have been weighted. A 15% strength deficit was shown at >12 months after surgery. INTERPRETATION Muscular strength assessment methods currently used to evaluate the strength after proximal hamstring rupture are too disparate to clearly define the strength deficit after rupture and surgery. Strength evaluation should be more rigorous in order to prove the real interest of the surgical management.
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Affiliation(s)
- Alban Fouasson-Chailloux
- CHU Nantes, Physical Medicine and Rehabilitation Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; CHU Nantes, Sports Medicine Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes F-44042, France.
| | - Pierre Menu
- CHU Nantes, Physical Medicine and Rehabilitation Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; CHU Nantes, Sports Medicine Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes F-44042, France
| | - Olivier Mesland
- CHU Nantes, Physical Medicine and Rehabilitation Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; CHU Nantes, Sports Medicine Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France
| | - Marc Dauty
- CHU Nantes, Physical Medicine and Rehabilitation Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; CHU Nantes, Sports Medicine Department, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 03, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes F-44042, France
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Brazilian Jiu Jitsu, Judo, and Mixed Martial Arts Injuries Presenting to United States Emergency Departments, 2008-2015. J Prim Prev 2019; 39:421-435. [PMID: 30043324 DOI: 10.1007/s10935-018-0518-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Limited research has systematically examined injuries resulting from Brazilian Jiu Jitsu (BJJ), Judo, and mixed martial arts (MMA), especially when compared to more well-known or -established martial arts. These three combative sports differ substantially regarding their rules and techniques. BJJ emphasizes ground positioning and submission, Judo rewards throwing an opponent on their back with submission ending the match, and MMA emphasizes knocking out or forcing the submission of one's opponent. We examined injuries, among people of any age, experienced from participation in BJJ, Judo, and MMA. We analyzed data from the United States (U.S.) Consumer Product Safety Commission National Electronic Injury Surveillance System to create estimates of injuries presenting to U.S. emergency departments (EDs). We compared injury profiles between sports, including estimated numbers of injuries, their site, type, and mechanism. Participation in BJJ, Judo, and MMA resulted in an estimated 39,181 injuries presenting to U.S. EDs from 2008 through 2015. Strains and sprains were the most common diagnoses for BJJ and Judo participants, whereas abrasions/contusions were the most commonly diagnosed MMA injury. Being struck resulted in the majority of injuries for all three sports. The head was the most injured body region for BJJ and MMA, whereas the leg was the most injured body region for Judo. Finally, the majority of BJJ and Judo injuries occurred during noncompetitive grappling, whereas most MMA injuries occurred during competition. Our study adds to the limited literature examining injuries from BJJ, Judo, and MMA using data from a probability sample and is an initial step towards understanding the national burden of injury from participation in these sports. Given the quantity and severity of injuries sustained by participants, additional research is needed to assess the riskiness of participation and the effectiveness of interventions, such as improved personal protective gear and mats, as a means to prevent commonly occurring injuries.
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van der Made AD, Hölmich P, Kerkhoffs GMMJ, Gouttebarge V, D’Hooghe P, Tol JL. Proximal hamstring tendon avulsion treatment choice depends on a combination of clinical and imaging-related factors: a worldwide survey on current clinical practice and decision-making. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ObjectivesTo evaluate current practice in the treatment of proximal hamstring tendon avulsions and identify decision-making preferences.MethodsAn invitation to an anonymous e-survey containing 32 questions was sent to 3475 members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the European College of Sports and Exercise Physicians (ECOSEP).ResultsWe received 403 (12%) unique responses with a completion rate of 79%. Participants were orthopaedic/trauma surgeons (90%), sports medicine physicians (7%) or physical therapists (2%). For 83% of the participants, the preferred treatment (ie, surgical or non-operative) depends on the individual case. Participants base their decision-making process on patient- and injury-related factors (decision modifiers). The five most frequently selected decision modifiers that support the choice for surgical treatment were diminished function (84%), neurological symptoms (74%), involved tendons (82%), tendon retraction on MRI (84%) and patient preference for surgery (78%). The majority prefer early surgical repair (<2 weeks after injury) to achieve highest functional outcome (63%) and ensure a low complication risk (61%). Suture anchors are used by 93% of the participants for tendon reattachment. Estimated recovery duration (ie, time to return to sports) was a median 12 weeks (IQR: 12–20) for non-operative treatment and 17 weeks (IQR: 12–24) for surgical treatment. Estimated reinjury risk was a median 25% (IQR: 10–31.5) and 10% (IQR: 5–20), respectively.ConclusionThis survey among experienced medical professionals has summarised current practice and identified treatment decision-making preferences. The typical surgical patient has a retracted (>2 cm) two-tendon avulsion (ie, common tendon and semimembranosus tendon), is unable to engage in sports or activities of daily life, reports sciatic symptoms and prefers surgical treatment. Surgery is thought to prolong recovery and decrease reinjury risk compared with non-operative treatment and is preferably performed early.Level of evidenceLevel V.
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Blakeney WG, Zilko SR, Edmonston SJ, Schupp NE, Annear PT. Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool. Knee Surg Sports Traumatol Arthrosc 2017; 25:1936-1942. [PMID: 27344550 DOI: 10.1007/s00167-016-4214-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the present study was to validate a new scoring system for proximal hamstring injury-the Perth Hamstring Assessment Tool (PHAT). METHODS This is a prospective series of 74 consecutive proximal hamstring surgical repairs in 72 patients, with a median age of 50.5 years (range 16-74). Patients completed the PHAT, SF12 Health Survey and Lower Extremity Functional Scale (LEFS). The scoring system was validated by calculating its internal consistency, reproducibility, reliability and sensitivity to change. Construct validity was evaluated using Pearson's correlation analysis to examine the strength of association between the PHAT, LEFS and SF-12 scores. RESULTS The PHAT showed high completion rate (100 %), high internal consistency (Cronbach's alpha 0.80), high reproducibility (ICC 0.84) and high sensitivity to change. There was moderate correlation with the LEFS and low correlation with the Physical Component Score of the SF-12. CONCLUSION This study has validated the PHAT as an assessment tool for proximal hamstring tendon injuries. The new questionnaire provides a measure of outcome that is reliable and sensitive to clinically important change. This simple questionnaire provides the clinician with a quick and practical tool for assessing patients with proximal hamstring injuries: to assess pre-operative disability and monitor recovery post-operatively. LEVEL OF EVIDENCE II.
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Affiliation(s)
- William G Blakeney
- Department of Orthopaedic Surgery, Fremantle Hospital, Fremantle, WA, Australia. .,Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - Simon R Zilko
- Department of Orthopaedic Surgery, Fremantle Hospital, Fremantle, WA, Australia
| | | | - Natalie E Schupp
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Peter T Annear
- Department of Orthopaedic Surgery, Mount Hospital, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine, West Perth, WA, Australia
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Buckwalter J, Westermann R, Amendola A. Complete proximal hamstring avulsions: is there a role for conservative management? A systematic review of acute repairs and non-operative management. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kuske B, Hamilton DF, Pattle SB, Simpson AHRW. Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review. PLoS One 2016; 11:e0152855. [PMID: 27144648 PMCID: PMC4856270 DOI: 10.1371/journal.pone.0152855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Hamstring tears are well recognised in the sporting population. Little is known about these injuries in the general population. Purpose Evaluating the rates, patterns and risk factors of non-sporting hamstring tears, compared to sporting related hamstring tears. Data Sources MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (1989–2015). Study Selection Studies reporting patients with a grade 2 or 3 hamstring muscle tear, identified clinically, confirmed by MRI imaging or direct visualisation during surgical exploration. Data Synthesis 144 sets of linked data were extracted for analysis. Most injuries were in males (81.3%), where mean age at injury was lower (30.2, 95% CI 29.1–31.3) than in females (35.4, 95% CI 32.4–38.4) p = 0.06. Key differences were found in the proportion of non-sporting injuries in patients under and over the age 40 (p = 0.001). The proportion of non-sporting injuries was significantly higher in females compared to males (25.9% female non-sporting injuries, versus 8.5% male; p = 0.02). Avulsions were more frequently reported in non-sporting activities (70.5%). The proportion of such injuries was notably higher in females, though this failed to meet significance (p = 0.124). Grouped by age category a bimodal distribution was noted, with the proportion of avulsions greater in younger (age <15) and older patients (age > 40) (p = 0.008). 86.8% of patients returned to pre-injury activity levels with a similar frequency across all study variables; age, activity (sporting vs non-sporting) and injury type (avulsion vs tear). Conclusion This review highlights a proportion of adults suffering grade 2 or 3 hamstring injuries from activities other than the classic sports trauma. The majority of these non-sporting injuries were avulsion injuries that clustered in older female and skeletally immature patients suggesting a potential link to bone mineral density.
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Affiliation(s)
- Barbara Kuske
- Department of General Medicine, NHS Lothian, Edinburgh, United Kingdom
| | - David F. Hamilton
- Department of Trauma and Orthopaedics, University of Edinburgh, Edinburgh, United Kingdom
| | - Sam B. Pattle
- Department of General Medicine, NHS Lothian, Edinburgh, United Kingdom
| | - A. Hamish R. W. Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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Barnett AJ, Negus JJ, Barton T, Wood DG. Reattachment of the proximal hamstring origin: outcome in patients with partial and complete tears. Knee Surg Sports Traumatol Arthrosc 2015; 23:2130-5. [PMID: 24420604 DOI: 10.1007/s00167-013-2817-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the subjective and functional outcome in complete and partial injuries, both acute and chronic. METHODS One hundred and thirty-two consecutive proximal hamstring reattachments were performed by a single surgeon between 1999 and 2009. The mean age at the time of operation was 42.5 years (SD 12.2), the mean duration of follow-up was 53.8 months (SD 19.5), and all patients with a minimum 2-year follow-up were included in the study. Patients were reviewed independently. Functional outcome was evaluated using quantitative assessments of pre-operative and postoperative hamstring strength and endurance, while subjective outcome was undertaken at the latest follow-up using a three-tier questionnaire. RESULTS The most common cause of injury was waterskiing (29 patients). There were 96 complete injuries and 36 partial injuries. Overall, 112 of 132 patients rated their result as good/excellent, 91 had returned to their pre-injury level of sporting activity, and 114 said that they would undergo surgery again. Mean postoperative hamstring strength was 83 %, and mean hamstring endurance was 108 % compared to the contralateral limb. Patients with complete injuries and those operated and those operated on acutely (<6 weeks) were more likely to have a good/excellent result. There was no significant correlation between time to repair, type of injury (partial vs. complete) and functional outcome. CONCLUSION Good to excellent results can be expected in the majority of patients, following surgical reattachment. Surgery is well tolerated with the vast majority of patients, reporting that they would undergo surgery again. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A J Barnett
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, 25 Rocklands Road, Sydney, NSW, 2060, Australia,
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Alzahrani MM, Aldebeyan S, Abduljabbar F, Martineau PA. Hamstring Injuries in Athletes: Diagnosis and Treatment. JBJS Rev 2015; 3:01874474-201506000-00005. [PMID: 27490012 DOI: 10.2106/jbjs.rvw.n.00108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohammad M Alzahrani
- Division of Orthopaedic Surgery, McGill University Health Center, 1650 Cedar Avenue, A5-175, Montreal, Quebec H3G 1A4, Canada
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Subbu R, Benjamin-Laing H, Haddad F. Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med 2015; 43:385-91. [PMID: 25404617 DOI: 10.1177/0363546514557938] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Avulsion of the proximal hamstring origin is well documented, and surgical treatment is advocated for complete avulsions. PURPOSE To compare the return to preinjury level of sport and the complexity of surgery in athletes undergoing surgical intervention for complete proximal hamstring avulsions within 6 weeks, 6 months, and after 6 months of injury. STUDY DESIGN Case series; Level of evidence, 4. METHODS This was the largest case series from a tertiary referral center reported in the literature. A total of 112 athletes were included, with complete proximal avulsion injuries confirmed on MRI scans; 63 patients (56.3%) were high-level athletes. Patients were divided into subgroups depending on the timing of surgical intervention: "early" was defined within 6 weeks, "delayed" within 6 weeks to 6 months, and "late" after 6 months. All patients were surgically explored and repaired with the aim of comparing the timing between each group and the return to preinjury sport. All patients underwent an individualized rehabilitation protocol. There was no loss to follow-up. The primary outcome measure was the return to preinjury level sports activity. RESULTS A total of 108 patients (96.4%) returned to sport. In the early intervention group, the average time of return to play was 16 weeks, 9 weeks faster than the delayed group and 13 weeks faster than the late group. There were 2 partial reruptures in those with delayed intervention—both athletes retired from competitive sport but were recreationally active. Two other athletes recovered well but retired from playing at all levels. Twelve athletes (2 in the early intervention group, 5 in the delayed, 5 in the late) were delayed by local nerve symptoms. Only 2 cases required further exploration. CONCLUSION Early surgical intervention was associated with good clinical outcomes and a quicker return to sport; however, delaying the diagnosis can lead to prolonged morbidity and an increased likelihood of complications.
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Affiliation(s)
- Raj Subbu
- Institute of Sport Exercise and Health, University College London Hospitals, London, UK
| | - Harry Benjamin-Laing
- Institute of Sport Exercise and Health, University College London Hospitals, London, UK
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London Hospitals, London, UK
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Hofmann KJ, Paggi A, Connors D, Miller SL. Complete Avulsion of the Proximal Hamstring Insertion: Functional Outcomes After Nonsurgical Treatment. J Bone Joint Surg Am 2014; 96:1022-1025. [PMID: 24951738 DOI: 10.2106/jbjs.m.01074] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Complete proximal hamstring avulsions are an uncommon injury. The purpose of this study was to determine the functional and subjective outcomes following nonsurgical management of complete proximal hamstring avulsions. METHODS We retrospectively identified nineteen patients (mean age, fifty-nine years; range, forty-four to seventy-three years) at one institution who presented with complete avulsions of the proximal hamstring insertion, confirmed on magnetic resonance imaging, and had nonsurgical treatment. Results on the Lower Extremity Functional Scale (LEFS) and Short Form-12 version 2 (SF-12v2) questionnaires as well as functional and isometric testing (with a handheld dynamometer) were collected. Seventeen patients completed the questionnaires. Ten patients underwent functional testing. The average follow-up period was thirty-one months (range, eight to 156 months). RESULTS The mean score on the LEFS was 70.2 of a maximum of 80 points. The mean SF-12v2 physical and mental component summary scores were 52.5 and 54.1, respectively. Hamstring strength at 45° and 90° of flexion was an average of 62% (p = 0.09) and 66% (p = 0.07), respectively, of that of the uninvolved limb. The single-leg hop test revealed an average decline of 2.2% (p = 0.93) compared with the uninvolved limb. Twelve of the seventeen patients were able to return to their previous sporting activities. CONCLUSIONS Nonsurgical management after a complete proximal hamstring avulsion yields noticeable subjective and strength deficits. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kurt J Hofmann
- Tufts Medical Center, 800 Washington Street, Box 306, Boston, MA 02111. E-mail address:
| | - Adam Paggi
- Orthopaedic & Sports Physical Therapy, 260 Tremont Street, Boston, MA 02112. E-mail address:
| | - Daniel Connors
- Jump Start Physical Therapy, 1 HF Brown Way, Natick, MA 01760. E-mail address:
| | - Suzanne L Miller
- Boston Sports and Shoulder Center, 830 Boylston Street, Suite 107, Chestnut Hill, MA 02167. E-mail address:
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O'Laughlin SJ, Flynn TW, Westrick RB, Ross MD. Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete: a case report. Int J Sports Phys Ther 2014; 9:371-376. [PMID: 24944856 PMCID: PMC4060315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Hamstring injuries are frequent injuries in athletes, with the most common being strains at the musculotendinous junction or within the muscle belly. Conversely, hamstring avulsions are rare and often misdiagnosed leading to delay in appropriate surgical interventions. The purpose of this case report is to describe the history and physical examination findings that led to appropriate diagnostic imaging and the subsequent diagnosis and expedited surgical intervention of a complete avulsion of the hamstring muscle group from the ischium in a military combatives athlete. CASE DESCRIPTION The patient was a 25 year-old male who sustained a hyperflexion injury to his right hip with knee extension while participating in military combatives, presenting with acute posterior thigh and buttock pain. History and physical examination findings from a physical therapy evaluation prompted an urgent magnetic resonance imaging (MRI) study, which led to the diagnosis of a complete avulsion of the hamstring muscle group off the ischium. OUTCOME Expedited surgical intervention occurred within 13 days of the injury potentially limiting comorbidities associated with delayed diagnosis. CONCLUSION Recognition of the avulsion led to prompt surgical evaluation and intervention. Literature has shown that diagnosis of hamstring avulsions are frequently missed or delayed, which results in a myriad of complications. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
| | | | - Richard B. Westrick
- United States Military – Baylor University Sports Physical Therapy Doctoral Program, West Point, NY, USA
| | - Michael D. Ross
- Department of Physical Therapy, University of Scranton, Scranton, PA, USA
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Sonnery-Cottet B, Archbold P, Thaunat M, Fayard JM, Canuto SMG, Cucurulo T. Proximal hamstring avulsion in a professional soccer player. Orthop Traumatol Surg Res 2012; 98:928-31. [PMID: 22926296 DOI: 10.1016/j.otsr.2012.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/09/2012] [Accepted: 05/03/2012] [Indexed: 02/02/2023]
Abstract
Acute hamstring strains are a common athletic injury, which may be treated non-operatively with a satisfactory outcome. A complete proximal hamstring avulsion is a rare and potentially career ending injury to an elite athlete. For these high demand patients, surgical reattachment should be immediately undertaken to shorten return to sport and to improve functional outcome. This report describes the occurrence of a complete avulsion of the proximal hamstrings in a professional footballer during an international match. We highlight the clinical presentation, the appropriate diagnostic investigations, the surgical technique and the rehabilitation protocol for this injury. The successful surgical reattachment of the common hamstring tendon was confirmed by magnetic resonance imaging done 5 months after repair and allowed the player a full return to competition at 6 months after surgery. Hamstrings isokinetic peak torque was 80% at 6 months and 106% at 11 months after repair comparing with the uninjured side.
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Affiliation(s)
- B Sonnery-Cottet
- Santy Orthopaedic Surgical Center, 24 avenue Paul-Santy, Lyon, France.
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16
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Chahal J, Bush-Joseph CA, Chow A, Zelazny A, Mather RC, Lin EC, Gupta D, Verma NN. Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal? Am J Sports Med 2012; 40:2325-30. [PMID: 22869623 DOI: 10.1177/0363546512453298] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of validated outcome questionnaires and magnetic resonance imaging (MRI) when assessing outcomes after surgical treatment of proximal hamstring avulsions has been limited. PURPOSE To comprehensively evaluate clinical, functional, and radiological outcomes in patients treated with surgical repair for complete proximal hamstring avulsions. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of 15 consecutive patients was performed. Outcome measures included the Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, Proximal Hamstring Injury Questionnaire, Lower Extremity Functional Scale (LEFS), Harris Hip Score (HHS), and Tegner Activity Scale (TAS). Physical examination was performed by an independent sports medicine fellow. Magnetic resonance imaging of the lower extremity was used to assess tendon healing and muscle quality after repair. RESULTS Thirteen of 15 (87%) eligible patients were available for follow-up at a mean 36.9 months (range, 27-63 months), including 8 men and 6 left-sided injuries. The average age was 44.6 years (range, 26-58 years). Twelve of 13 patients underwent surgical repair within 60 days of injury. Mean (± standard deviation) postoperative functional outcome scores were as follows: LEFS, 74.9 ± 7.8 (range, 59-80); HHS, 90.7 ± 13.9 (range, 67-100); SANE, 93.6 ± 7.5 (range, 75-100); VAS for pain, 1.3 ± 1.9 (range, 0-5); and TAS, 4.6 ± 2.3 (range, 1-7). All 11 patients who participated in sports before surgery were able to return to sport, but 45% reported a decrease in their current level of activity. Isokinetic muscle testing demonstrated that injured hamstring strength recovered up to 78% ± 6.1% (range, 74%-88%) of the contralateral side. The MRI examinations revealed that 100% of patients had a healed proximal hamstring repair, with signs of tendinopathy and mild atrophy in 3 of 12 patients. CONCLUSION The current findings indicate that surgical repair of complete hamstring ruptures provides reliable pain relief, good functional outcomes, high satisfaction rates, and excellent healing rates (MRI) but does not fully restore hamstring function and sports activity to preinjury levels.
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Affiliation(s)
- Jaskarndip Chahal
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL 60622, USA
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17
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Abstract
Proximal hamstring avulsions from the ischium are becoming more frequently recognized, secondary to their disability when treated nonoperatively. The acute repair of these injuries is becoming prevalent given the improved outcomes reported in the literature. Anatomic studies have recently been conducted on the proximal hamstring origin; however, there are few reports on surgical techniques for repair in the setting of injury. The present article describes the technique for proximal hamstring avulsion repair, as performed by the senior author. More than 30 cases have been performed based on this technique, with excellent results.
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Affiliation(s)
- Mathew Pombo
- Sports Medicine and Orthopaedic Institute of Gwinnett, Duluth, Georgia
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19
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Chua SGK, Kong KH. Complete semimembranosus rupture following therapeutic stretching after a traumatic brain injury. Brain Inj 2009; 20:669-72. [PMID: 16754292 DOI: 10.1080/02699050600676842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute hamstring rupture is an uncommon event often occurring during high impact sports. Such events have not been previously reported during neurological rehabilitation. This case report describes a 30 year-old Chinese male presenting in a minimally responsive state 5 years after a severe traumatic brain injury. He was tetraplegic and bed-bound with spasticity involving all four limbs and flexion contracture of the right knee. During an episode of inpatient rehabilitation, he developed acute swelling and bruising of the posterior proximal thigh region associated with fever, tachycardia and diaphoresis. MRI showed a large soft tissue rim-enhancing mass in the right proximal hamstring muscle. During surgical exploration, complete rupture of the right semi-membranosus muscle was found without evidence of pus. The possible causative factors of hamstring rupture in this subject and a brief literature review are discussed. To the authors' knowledge, this is the first such reported case.
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Affiliation(s)
- S G Karen Chua
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore.
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20
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Avulsion of the Hamstring Muscle Group: A Follow-Up of 6 Adult Non-Athletes with Early Operative Treatment: A Brief Report. World J Surg 2009; 33:1605-10. [PMID: 19533218 DOI: 10.1007/s00268-009-0099-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. INTERNATIONAL ORTHOPAEDICS 2009; 34:119-23. [PMID: 19252829 DOI: 10.1007/s00264-009-0739-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 01/26/2009] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to investigate the outcome of surgical management of acute complete proximal hamstring tendon tears. This was a prospective review of a case series from a tertiary referral centre. Ten patients presenting with complete proximal hamstring tendon tears were confirmed on MRI. All patients underwent surgical exploration and repair of the torn tendons with the aim of returning to normal activities and sports. Isokinetic muscle testing was performed using a dynamometer. The Cybex dynamometer (Cybex International, Ronkonkowa, NY) testing revealed almost comparable readings for the operated versus the non-operated side. An average peak torque of the operated hamstring muscles of 82.78% (range 47.16-117.88%), compared to the contralateral leg, was noted at six months. An excellent outcome was found in terms of return to normal activities and sports. Early surgical repair and physiotherapy has been noted to be associated with a good outcome and enables an early return to high level sports after complete tear of the proximal hamstring tendons.
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Abstract
BACKGROUND The torn hamstring is a common athletic injury. The purpose of the present study was to review the clinical presentation of this injury, the diagnostic imaging findings, the surgical technique of reattachment, and the likely clinical outcome of surgery for the treatment of avulsion of the proximal hamstring origin. METHODS Seventy-two consecutive reconstructions in seventy-one patients with avulsion of the proximal hamstring origin were performed at a single center. The mean age at the time of the operation was 40.2 years. The mean duration of follow-up was twenty-four months, and all patients with a minimum duration of follow-up of six months were included. There were no exclusions. Patients were independently reviewed, and the mean postoperative isotonic hamstring strength was compared with that on the uninjured side. RESULTS Waterskiing was the most frequent cause of injury (twenty-one cases). The mean time between the injury and the operation was twelve months. The most common pathological finding was a complete avulsion of the proximal hamstring origin (sixty-three cases; 87.5%), with a mean retraction of 7 cm (range, 0 to 20 cm). The mean postoperative isotonic hamstring strength measured 84% (range, 43% to 122%) and the mean postoperative hamstring endurance measured 89% (range, 26% to 161%) when compared with the values on the contralateral side. CONCLUSIONS It is important to distinguish proximal hamstring origin avulsions (for which we recommend early surgical repair) from the majority of hamstring muscle injuries (which respond well to nonoperative treatment). The present study suggests that, in cases of complete avulsion with hamstring retraction, a delay in surgical repair renders the repair more technically challenging, may increase the likelihood of sciatic nerve involvement, increases the need for postoperative bracing, and reduces postoperative outcome in terms of hamstring strength and endurance. Once the nature of the injury has been established, the surgical treatment of hamstring origin avulsions has predictable and satisfactory results.
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Affiliation(s)
- David G Wood
- North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Highway, Crows Nest, Sydney, NSW 2065, Australia.
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23
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Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008; 36:1110-5. [PMID: 18319349 DOI: 10.1177/0363546508314427] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Complete proximal hamstring avulsions can cause considerable morbidity and are often associated with significant functional loss. HYPOTHESIS Early surgical treatment leads to better results than does surgery in the chronic phase. STUDY DESIGN Case series; Level of evidence, 4. METHODS Forty-one patients (21 men and 20 women) with a complete proximal hamstring avulsion were included. The cases were retrospectively analyzed, and a 4-category rating system was used to evaluate the overall result of the surgical treatment. RESULTS The mean follow-up was 37 months (range, 12-72 months). Nineteen patients were rated as having an excellent result and 10 patients a good result. In 5 patients, the result was classified as moderate and in 7 patients poor. In the patients with an excellent or good result, the delay from the injury to surgery averaged 2.4 months, whereas in patients with a moderate or poor result, the delay averaged 11.7 months. The difference was statistically significant (P < .001). CONCLUSION Excellent or good results can often be expected with surgery, and considerable improvement of symptoms may be achieved even in chronic cases. According to the results, early operative treatment in complete proximal avulsions of the hamstring muscles gives better results than does late surgery and is therefore recommended.
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Affiliation(s)
- Janne Sarimo
- Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland
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24
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Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008; 36:104-9. [PMID: 18055919 DOI: 10.1177/0363546507312167] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute surgical repair of proximal hamstring ruptures has been shown to result in a high return to preinjury activity level. HYPOTHESIS Achilles allograft reconstruction of chronic complete proximal hamstring ruptures results in improved function and strength that approaches that of acute surgical repairs. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Between 2002 and 2005, 26 patients underwent surgical treatment for complete proximal hamstring ruptures. Twenty-one were acute primary repairs. Five chronic ruptures were treated with Achilles allograft reconstruction with (n = 2) or without (n = 2) interference screw fixation or mobilization and primary repair (n = 1). Isokinetic strength testing was conducted postoperatively in 11 acute and 3 chronic cases, and a functional questionnaire was given at most recent follow-up. RESULTS Subjective results for all patients at a mean follow-up of 20 months revealed good leg control in 96%, no pain in 80%, and return to sporting activities in 76%. Ninety-six percent of patients said they would have the procedure done again. With the isokinetic testing available at most recent follow-up, there was no significant difference in the mean hamstring strength deficits for the acute versus chronic groups tested at 60 deg/s (8% vs 21%, P =.295) and 180 deg/s (12% vs 2%, P = .294). Overall, there were 3 major adverse events and 5 patients with superficial wound drainage treated with antibiotics. CONCLUSION Surgical treatment of acute and chronic complete proximal hamstring ruptures can result in a high return to full activity. Reconstruction of chronic ruptures with Achilles allograft appears to restore function and strength comparable to acute repairs.
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Affiliation(s)
- Greg J Folsom
- Minnesota Sports Medicine Orthopaedic Sports Medicine Fellowship Program, Twin Cities Orthopaedics, Eden Prairie, Minnesota 55344, USA
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25
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Abstract
AIMS To investigate the type and severity of injury sustained during judo competitions, and to investigate any possible correlation between injury rate and gender, grade, weight category and rapid weight loss. METHOD Three hundred and ninety-two judokas (284 males, 108 females) competed in three consecutive competitions. A judoka was "injured" if they requested medical treatment or could not continue. Following injury, a questionnaire was completed. Uninjured judokas were asked to complete a questionnaire at one competition to assess risk factors of injury. Follow-up was conducted 6 weeks after each competition. RESULTS Fifty-three out of 392 judokas (13.5%) (40 males, 13 females) sustained an injury. No difference was found between injury rates among males (41.3/1000 anthlete-exposures (A-E's)) and females (40.9/1000 A-E's), or between judokas of different weight groups or grades. Rapid weight loss of 5% or more of a judoka's body weight placed the athlete at a higher risk of injury (P=0.022). Most injuries affected the upper extremities. Injuries most often resulted from grip fighting, being thrown, or attempting to throw. CONCLUSIONS Judokas are advised not to lose weight before a competition as this increases the risk of injury. Neither grade, nor gender, or weight category are associated with an increase in injury rate.
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Affiliation(s)
- C M Green
- Sheffield Centre of Sports Medicine, Division of Clinical Sciences South, University of Sheffield, Sheffield, UK
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26
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Gidwani S, Bircher MD. Avulsion injuries of the hamstring origin - a series of 12 patients and management algorithm. Ann R Coll Surg Engl 2007; 89:394-9. [PMID: 17535619 PMCID: PMC1963576 DOI: 10.1308/003588407x183427] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Injuries to the origin of the hamstring muscles usually occur in athletes and can result in an avulsion fracture of the ischium, an avulsion of the ischial apophysis, or a pure avulsion of the hamstring tendons themselves, depending on the patient's age. These are rare injuries in the general population and are often initially misdiagnosed as a simple 'hamstring pull', leading to the development of chronic pain and disability. PATIENTS AND METHODS We present a retrospective case series of the 12 patients with such injuries who presented or were referred consecutively to the senior author between 1997 and 2006. RESULTS There was a significant delay (5 months to 12 years) in the diagnosis of the injury in 8 of the 12 patients. Five of these 8 patients required more extensive surgery than would otherwise have been required as a result of this delay, but all recovered well. The sporting career of one of the remaining three patients had already been brought to an end by her injury and the subsequent disability, and she elected not to have surgery. Of the four patients who were diagnosed acutely, three required surgery, and all four had an excellent result. CONCLUSIONS Injuries to the hamstring origin are rare and are often initially misdiagnosed as a simple 'hamstring pull', leading to the development of chronic pain and disability. Displaced injuries of the ischial apophysis and pure tendon avulsions are probably best treated surgically in the acute setting. As a result of our experience with these patients, we have produced a management algorithm.
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Affiliation(s)
- Sam Gidwani
- Department of Trauma and Orthopaedics, St George's Hospital, London, UK.
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27
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Brucker PU, Imhoff AB. Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2005; 13:411-8. [PMID: 15602681 DOI: 10.1007/s00167-004-0563-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2003] [Accepted: 07/08/2004] [Indexed: 10/26/2022]
Abstract
Nonoperative treatment of acute or chronic complete ruptures of the proximal hamstring tendons leads to functional impairment in sports activities. The objective of the study was to evaluate the functional status after primary and delayed surgical treatment including objective (isokinetic hamstring and quadriceps muscle testing, hamstring flexibility) and subjective parameters (overall satisfaction, postoperative sports level). A total of eight patients (six male, two female) with an average age of 40.0 years (range 23-60) were treated operatively by refixation of the ruptured tendons in anatomical position using a suture anchor system. Six patients were treated within 3 weeks after trauma, while two patients were operated after delayed diagnosis of more than 2 months. The average clinical follow-up was 33.3 months (range 12-59). Overall, at minimum follow-up of 20 months, all patients were satisfied with the functional outcome and would undergo operative treatment again. At follow-up, seven patients could return to their preinjury sports level. In two patients, however, we noticed a delayed return to preinjury sports level of more than 24 months. The peak torque of the operated hamstrings in isokinetic muscle testing was 88.3% (range 62.9-113.8), as compared to the contralateral extremity. The ratio of hamstring to quadriceps muscle strength was on average 0.55 (range 0.44-0.66; injured side) versus 0.61 (range 0.52-0.68; uninjured side). Measurement of hamstring flexibility showed no difference to the contralateral hamstrings. In cases of timely diagnosis, surgical treatment is the standard treatment for complete ruptures of the proximal hamstring tendons in patients with ambitions inclined toward sports. The suture anchor system implements an elegant and effective technique for the treatment of such lesions.
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Affiliation(s)
- Peter U Brucker
- Orthopaedic Sports Medicine, Technical University Munich, Connollystrasse 32, 80809 Munich, Germany
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28
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Regauer M, Kettler M, Schieker M, Kanz KG, Mutschler W. [Complete rupture of the proximal semimembranosus tendon. Minimally invasive surgical repair by use of a suture anchor in a rare but often underestimated injury]. Unfallchirurg 2005; 108:1072, 1074-7. [PMID: 15959747 DOI: 10.1007/s00113-005-0943-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Complete rupture of the proximal semimembranosus tendon is a rare injury associated with significant functional loss. Conservative treatment has proven inadequate in returning patients to their previous activity level. However, diagnosis is often delayed because of underestimation of the severity of this injury. Satisfactory results can be achieved with both early and late surgical tendon repair in the majority of cases. However, repair delayed by more than 4 weeks post trauma usually requires extended mobilisation of the injured muscle and neurolysis of the sciatic nerve. Therefore, we recommend surgical repair as early as possible. We report on the successful minimally invasive surgical repair of a complete rupture of the proximal semimembranosus tendon by use of a suture anchor 18 days after injury.
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Affiliation(s)
- M Regauer
- Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München.
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29
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Abstract
Increasing activity in the general population and the high demands placed on athletes have resulted in injuries to the hamstring muscle complex (HMC) being commonplace in sports. Imaging of HMC injuries can form a considerable part of a sports medicine practice, with a wide spectrum of such injuries being reflected in their varied imaging appearances. Magnetic resonance (MR) imaging and ultrasonography (US) are the imaging modalities of choice in this setting. Both MR imaging and US provide exquisitely detailed information about the HMC with respect to localization and characterization of injury. Optimization of MR imaging involves the use of a surface coil and high-resolution techniques, allowing the musculoskeletal radiologist not only to diagnose injury and assess severity but also to provide the clinician with useful clues with respect to prognosis. The portability and availability of US make it an attractive modality for the diagnosis of acute hamstring injuries, although its effectiveness is dependent on operator experience. A thorough knowledge of the HMC anatomy and of the spectrum of imaging findings in HMC injury is crucial for providing optimal patient care and will enable the musculoskeletal radiologist to make an accurate and useful contribution to the treatment of athletes at all levels of participation.
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Affiliation(s)
- George Koulouris
- Department of Radiology, The Alfred Hospital, Melbourne, Australia
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Bencardino JT, Kassarjian A, Palmer WE. Magnetic resonance imaging of the hip: sports-related injuries. Top Magn Reson Imaging 2003; 14:145-60. [PMID: 12777887 DOI: 10.1097/00002142-200304000-00004] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Normal hip disorders do not account for a large proportion of exercise-related injuries, but they can pose a clinical dilemma because symptoms tend to be nonspecific. Conventional radiographs may demonstrate some causes of hip pain, such as stress fractures and degenerative joint disease. Magnetic resonance imaging (MRI) of the hip has proven valuable in the diagnosis of radiographically occult osseous abnormalities and periarticular soft-tissue disorders such as stress fractures, avulsion injuries, musculotendinous abnormalities, and bursitis. Conventional MRI has been less useful in the evaluation of intra-articular lesions, including acetabular labral tears, intra-articular loose bodies, and cartilage lesions. Visualization of intra-articular structures and their abnormalities can be improved by injection of diluted gadolinium, which distends the capsule and leaks into labral tears. This article focuses on the use of conventional radiography and MRI in recreational and professional athletes with painful hip joints. Where possible, MRI is compared with other diagnostic modalities such as bone scan and computed tomography.
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Affiliation(s)
- Jenny T Bencardino
- Department of Radiology, Massachusetts, General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
Sports are part of the sociocultural fabric of all countries. Although different sports have their origins in different countries, many sports are now played worldwide. International sporting events bring athletes of many cultures together and provide the opportunity not only for athletic competition but also for sociocultural exchange and understanding among people. This article reviews five major sports with international appeal and participation: cricket, martial arts, field hockey, soccer, and tennis. For each sport, the major aspects of physiological and biomechanical demands, injuries, and prevention strategies are reviewed.
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Affiliation(s)
- Dilip R Patel
- Michigan State University Kalamazoo Center for Medical Studies, 49008, USA.
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34
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Abstract
Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.
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35
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Abstract
Normal hip joint function is fundamental in running-, jumping-, and kicking-based sporting activities. Hip disorders do not account for a large portion of exercise-related injuries, but they can pose a clinical dilemma since symptoms tend to be non-specific. Conventional radiographs may demonstrate some causes of hip pain, such as stress fractures and degenerative joint disease. Magnetic resonance (MR) imaging of the hip has proven valuable in the diagnosis of radiographically occult osseous abnormalities and periarticular soft tissue disorders such as stress fractures, avulsion injuries, musculotendinous abnormalities, and bursitis. Conventional MR imaging has been less useful in the evaluation of intra-articular lesions including acetabular labral tears, intra-articular loose bodies, and cartilage lesions. The visualization of intra-articular structures and their abnormalities can be improved by the injection of diluted Gadolinium, which distends the capsule and leaks into labral tears. This article will focus on the use of conventional radiography and MR imaging in recreational and professional athletes with painful hip joints, and where possible it will compare MR imaging with other diagnostic modalities such as bone scan and CT.
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Affiliation(s)
- Jenny T Bencardino
- Division of Bone and Joint Radiology, Massachusetts General Hospital, Boston 02114, USA.
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36
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De Smet AA, Best TM. MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 2000; 174:393-9. [PMID: 10658712 DOI: 10.2214/ajr.174.2.1740393] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Although hamstring injuries are common in athletes, the distribution and location of such injuries have not been well defined. We used MR imaging to determine the frequency of injury by muscle, involvement of one or more muscles, and location of injuries within the musculotendinous unit. SUBJECTS AND METHODS We performed MR imaging on 15 consecutive college athletes with clinically diagnosed acute hamstring injuries. A hamstring injury was diagnosed and located on MR imaging by identifying high signal intensity within the muscle on T2-weighted images. RESULTS We found that 10 athletes had injuries of a single muscle with six injuries of the biceps femoris, three of the semitendinosus, and one of the semimembranosus. In an additional five athletes, we found primary injuries of the biceps femoris and secondary injuries of the semitendinosus. The injuries occurred in diverse locations within the muscles including five injuries at the proximal musculotendinous junction, two at the distal musculotendinous junction, four within the proximal half of the muscle belly, and four in the distal half. All eight intramuscular injuries were located at the musculotendinous junction within the muscle. CONCLUSION The biceps femoris is the most commonly injured hamstring muscle and the semitendinosus is the second most commonly injured. Although hamstring injuries often involve one muscle injured proximally, multiple muscles were involved in 33% of athletes (5/15) and the injuries were distal in 40% of athletes (6/15). All intramuscular injuries occurred at the musculotendinous junction, either at the ends of the muscle or within the muscle belly.
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Affiliation(s)
- A A De Smet
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison 53792-3252, USA
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38
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Thomsen NO, Jensen TT. Late repair of rupture of the hamstring tendons from the ischial tuberosity--a case report. ACTA ORTHOPAEDICA SCANDINAVICA 1999; 70:89-91. [PMID: 10191758 DOI: 10.3109/17453679909000967] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N O Thomsen
- Department of Orthopaedic Surgery, Hvidovre Hospital, Denmark
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