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Mendel T, Steinke M, Schenk P, Migliorini F, Schütte V, Reisberg A, Kobbe P, Heinecke M. Conservative management of proximal hamstring avulsion: A clinical study. J Orthop 2024; 55:74-79. [PMID: 38665987 PMCID: PMC11039336 DOI: 10.1016/j.jor.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction The management of proximal hamstring tear (PHT) is debated and consensus regarding recommended measures and individual treatment regimens is lacking. The present investigation evaluated the efficacy of a conservative management of partial and complete PHT. Methods The present observational study was conducted following the STROBE statement. In June 2018 the medical databases of the BG Klinikum Bergmannstrost Halle, Germany were accessed. All the patients with PHT were retrieved. The outcomes of interest were to evaluate the clinical examination, PROMs, imaging, and isokinetic muscle strength at the baseline and last follow-up. Results 31 patients were enrolled in the present study. Nine patients (29 % (9 of 31) described local pain at the ischial tuberosity in sitting situations and also in manual palpation. A persistent gap in the tendon string beneath the tuberosity in manual palpation was reported in 25.8 % (8 of 31). The mean VAS at the last follow-up was 2.3 ± 2.3. The mean LEFS score was 50.9 ± 18.8.Control MRI at follow-up showed scarring restitution in the proximal tendon in all patients in the partial tear group. In the complete tear group, a persisting defect state of the proximal tendon course was found in 45 % (9 of 20). The injured side achieved 81.5 ± 22.2 % of the force of the uninjured side, measured in the flexion movement at 60°/s. At an angular velocity of 240°/s, 83.2 ± 26.3 % of the force of the uninjured side was achieved. Conclusion According to the main findings of the present study, conservative therapy of PTH tears is associated with good clinical outcomes. High-quality investigations are required to establish the proper therapeutic algorithm and advantages of conservative management compared to a surgical approach. Level of evidence Level III.
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Affiliation(s)
- Thomas Mendel
- BG Hospital Bergmannstrost Halle, Department of Trauma and Reconstructive Surgery, Halle, Germany
- University Hospital Halle, Martin Luther University Halle-Wittenberg, Department of Trauma Surgery, Halle, Germany
| | - Mark Steinke
- BG Hospital Bergmannstrost Halle, Department of Trauma and Reconstructive Surgery, Halle, Germany
| | - Philipp Schenk
- BG Hospital Bergmannstrost Halle, Research Executive Department, Halle, Germany
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100 Bolzano, Italy
| | - Vincent Schütte
- Gesundheitszentrum Halle-Neustadt, Center Orthopaedic Surgery, Halle, Germany
| | - André Reisberg
- BG Hospital Bergmannstrost Halle, Department of Radiology and Neuroradiology, Halle, Germany
| | - Philipp Kobbe
- BG Hospital Bergmannstrost Halle, Department of Trauma and Reconstructive Surgery, Halle, Germany
- University Hospital Halle, Martin Luther University Halle-Wittenberg, Department of Trauma Surgery, Halle, Germany
| | - Markus Heinecke
- Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department, Eisenberg, Germany
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Lefèvre N, Moussa MK, Chahal A, Meyer A, Grimaud O, Khalaf ZM, Alayane A, Bohu Y, Hardy A. The Cobra sign: A marker for overestimation of tendon retraction in proximal semimembranosus tendon avulsion. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39171445 DOI: 10.1002/ksa.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE To introduce a new magnetic resonance imaging (MRI) sign, termed the Cobra sign, and identify its diagnostic metrics. The secondary aim was to demonstrate that this sign can be a source of false evaluation of tendon retraction in patients with proximal hamstring avulsion injury. METHOD This retrospective cohort study targeted patients surgically treated for proximal hamstring avulsion injury from January 2019 to June 2023. The MRI Cobra sign was defined as a wavy curved T2-hypointense band with the free end folding distally over itself, resembling a cobra head. The primary outcome measure was the characterization of the Cobra sign in patients with proximal hamstring avulsion injury. The secondary outcome was the association of this sign with tendon retraction. The study included 81 proximal hamstring avulsion injury patients (mean age of 45.7, SD = 13.9), with 41 (50.6%) complete avulsions, 33 semimembranosus, and 7 conjoint tendons. RESULTS The MRI Cobra sign was found in 25 patients (17 semimembranosus and 8 complete). It was confirmed surgically only in semimembranosus cases. It demonstrated 51.5% sensitivity and 83.3% specificity for isolated semimembranosus avulsions, with a significant positive likelihood ratio of 3.0. MRI retraction was 10.05 cm (±3.0), reducing to 7.9 cm (±2.5) on surgical measurement (mean difference = 2.0 cm, p < 0.001). The regression analysis confirmed MRI retraction's influence on the Cobra sign, with a 1.4 odds increase per unit (p < 0.001). In linear regression analysis, each unit increase in MRI retraction corresponded to a 79% increase in surgical retraction (coefficient 0.7, t = 11.1, p < 0.001). CONCLUSION The Cobra sign demonstrated acceptable diagnostic accuracy for isolated semimembranosus avulsion, with a high specificity of 83.3%, a low sensitivity of 51.5%, and a positive likelihood ratio of 3.0. The presence of the Cobra sign indicates an overestimated MRI retraction by approximately 21%. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Mohamad K Moussa
- Department of Orthopedic Surgery, Group Hospitalier Sélestat Obernai, Séléstat, Alsace, France
| | - Ahmad Chahal
- Department of Radiology, Hôpital Saint Camille, Bry-sur-Marne, France
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Pihl E, Laszlo S, Rosenlund AM, Kristoffersen MH, Schilcher J, Hedbeck CJ, Skorpil M, Micoli C, Eklund M, Sköldenberg O, Frihagen F, Jonsson KB. Operative versus Nonoperative Treatment of Proximal Hamstring Avulsions. NEJM EVIDENCE 2024; 3:EVIDoa2400056. [PMID: 39023393 DOI: 10.1056/evidoa2400056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Operative treatment is widely used for acute proximal hamstring avulsions, but its effectiveness compared with that of nonoperative treatment has not been shown in randomized trials. METHODS In this noninferiority trial at 10 centers in Sweden and Norway, we enrolled patients 30 to 70 years of age with a proximal hamstring avulsion in a randomized trial and a parallel observational cohort. Treatments were operative reinsertion of the tendons or nonoperative management. The primary end point was the Perth Hamstring Assessment Tool (PHAT) at 2 years of follow-up. Secondary outcomes included scores on the Lower Extremity Functional Scale (LEFS). RESULTS A total of 119 patients were enrolled in the randomized trial and 97 patients in the observational cohort. In the per-protocol analysis of the randomized trial, the mean (±standard deviation) PHAT scores were 79.9±19.5 and 78.5±19.4 in the operative and nonoperative groups, respectively (PHAT scores range from 0 to 100, with higher scores indicating higher function). The prespecified noninferiority limit of 10 points was not crossed (mean difference, -1.2; 95% confidence interval [CI], -8.6 to 6.2; P=0.009 for noninferiority). Analyses of secondary outcomes, including a mean difference in the LEFS score of -1.6 (95% CI, -5.2 to 2.0), aligned with the primary outcome. The observed numbers of adverse events in the randomized trial were nine in the operative group versus three in the nonoperative group (odds ratio, 0.3; 95% CI, 0.1 to 1.2). In the analysis of the observational cohort, the mean PHAT score difference between the nonoperative and operative treatment groups was -2.6 (95% CI, -9.9 to 4.6). CONCLUSIONS In patients 30 to 70 years of age with proximal hamstring avulsions, nonoperative treatment was noninferior to operative treatment. (Funded by Afa Försäkring and others; ClinicalTrials.gov number, NCT03311997.).
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Affiliation(s)
- Elsa Pihl
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm
- Department of Orthopedics, Danderyds Hospital, Stockholm
| | - Sofia Laszlo
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Anne-Mari Rosenlund
- Institute of Clinical Medicine, University of Oslo, Oslo
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo
| | | | - Jörg Schilcher
- Department of Orthopedic Surgery and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| | - Carl Johan Hedbeck
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm
- Department of Orthopedics, Danderyds Hospital, Stockholm
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | - Chiara Micoli
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm
- Department of Orthopedics, Danderyds Hospital, Stockholm
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Kenneth B Jonsson
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Lefèvre N, Coughlan A, Valentin E, Sezer HB, Bohu Y, Moussa MK, Hardy A. Magnetic resonance imaging should be the first-line imaging modality for investigating suspected proximal hamstring avulsion injuries. Knee Surg Sports Traumatol Arthrosc 2024; 32:1862-1870. [PMID: 38769849 DOI: 10.1002/ksa.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The purpose of the study was to evaluate how the initial diagnostic tool used-specifically ultrasound (US) or magnetic resonance imaging (MRI)-for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries. METHODS This was a retrospective analysis of prospectively collected data (2012-2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US-first vs. MRI-first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA) Activity Scale and Tegner Activity Scale. RESULTS The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI-first group and 47.6 ± 12.0 years for US-first group. Patients in the MRI-first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range [IQR]: 11.0-61.0) compared to 30 days (IQR: 18-74) in the US-first group. At the final follow-up (4.2 ± 2.2 years for the MRI-first group and 5.1 ± 1.9 years for the US-first group), the MRI-first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US-first group: The Tegner Activity Scale was median 5 (IQR: 3-7) for the MRI-first group versus median 4 (IQR: 2-6) for the US-first group (p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI-first group compared to 7.3 ± 2.4 for the US-first group (p < 0.05). This difference was more pronounced when comparing the MRI-first group with the patient-false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score. CONCLUSION MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Adam Coughlan
- Clinique du sport, Paris, France
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | | | | | - Mohamad K Moussa
- Clinique du sport, Paris, France
- Groupe Hospitalier Sélesta-Obernai, Sélesta, France
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Lefevre N, Kassab Hassan S, Valentin E, Bohu Y, Gerometta A, Meyer A, Grimaud O, Hardy A. Validation of the Parisian Hamstring Avulsion Score (PHAS) in the Evaluation and Follow-up of Patients Operated for Proximal Hamstring Avulsion. Am J Sports Med 2024; 52:1014-1021. [PMID: 38353118 PMCID: PMC10943598 DOI: 10.1177/03635465241227434] [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: 04/15/2023] [Accepted: 12/06/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND No validated score is available for the prediction of return to sport (RTS) after proximal hamstring avulsion (PHA) surgery. PURPOSE To validate a new assessment tool for patients after PHA surgery: the Parisian Hamstring Avulsion Score (PHAS). STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS All patients at our clinic who had surgery for PHA between January 2015 and March 2018 were included in this study. A suspected clinical diagnosis of PHA was confirmed by magnetic resonance imaging. PHA was repaired by surgical reinsertion with suture anchors. Minimum postoperative follow-up was 2 years, and the PHAS, University of California, Los Angeles (UCLA), score, and Tegner score were used. The PHAS is a patient-reported outcome measure, evaluating the effect of PHA injury with 9 items. It was validated by calculating its psychometric properties, and then correlation analysis was performed to determine the relationship between the PHAS, UCLA score, and Tegner score. Cutoff values for the prediction of RTS were determined. RESULTS A prospective case series study was performed. A total of 156 patients were included. Median age (first quartile; third quartile) was 54.2 years (44.7 years; 61.3 years), and the mean ± SD time of the final follow-up was 69 ± 11.6 months. Two years after surgery, 66.7% (n = 104) of patients were able to RTS. A strong correlation was noted between all 3 scores at 1 year postoperatively. Overall internal consistency was high, with a Cronbach alpha coefficient of 0.86. The intraclass correlation coefficient was 0.96, showing excellent reliability. The minimal detectable change was 12.9. No patients reached the maximum score at 2 years. Analysis of the receiver operating characteristic curves of the 3 scores at postoperative 9 months in relation to the RTS at 1 and 2 years showed area under the curve values of >0.7, indicating significant discriminant capacity for the RTS. A PHAS cutoff value of 86 at 9 months for the prediction of RTS at postoperative 1 year had a sensitivity of 65.6% (95% CI, 53.7%-77.5%) and a specificity of 81.4% (95% CI, 69.8%-93%). CONCLUSION PHAS is a valid and reliable tool for follow-up after PHA surgery. It also offers a simple way to predict RTS.
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Affiliation(s)
| | | | | | - Yoann Bohu
- Clinique du Sport Paris V, Paris, France
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Lefèvre N, Moussa MK, Valentin E, Meyer A, Bohu Y, Gerometta A, Khiami F, Grimaud O, Khalaf Z, Hardy A. Predictors of Early Return to Sport After Surgical Repair of Proximal Hamstring Complex Injuries in Professional Athletes: A Prospective Study. Am J Sports Med 2024; 52:1005-1013. [PMID: 38353018 PMCID: PMC10943609 DOI: 10.1177/03635465231225486] [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: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Proximal hamstring complex injury (PHCI) is a common injury among professional athletes, particularly those participating in pivot contact sports. Previous studies have suggested that surgery can be effective in restoring function and allowing athletes to return to sport (RTS), but the factors influencing successful RTS have been less clear. PURPOSE To assess RTS capabilities after surgical treatment of PHCI in professional athletes and to identify favorable predictors of RTS. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study (2002-2022) was conducted on professional athletes who underwent surgical treatment for PHCI at a sports surgery center. The primary outcome of the study was the RTS capability, evaluated based on the rate of athletes' return to their preinjury level of competition, time delay to RTS, and quality of RTS as measured using their level of performance and progression of scores on activity scales such as the Tegner Activity Scale (TAS) and University of California, Los Angeles (UCLA), scale. "Maintained performance" was defined as athletes returning to the same preinjury activity level (per the TAS and UCLA scale) and perceiving themselves to have maintained their performance. Secondary outcomes covered the potential RTS predictors and complication rate. The study distinguished 2 types of PHCI: proximal hamstring tendon avulsion injury (proximal rupture with empty footprint, or having a "positive dropped ice cream sign") and complete proximal hamstring free tendon rupture (PHTR; proximal rupture without empty footprint, or having a "negative dropped ice cream sign"). RESULTS The study examined 64 professional athletes (mean age, 27.3 years; 82.8% male) undergoing surgery for PHCI. The RTS rate was 98.4%, with 78.1% of the athletes returning to their preinjury level of competition at 6.2 months (SD, 2.5 months). Twelve (19%) patients had returned to sport at an inferior level of competition, and 2 (3.1%) were unable to continue in their preinjury sport. Subgroup analysis revealed variation in RTS based on sport type, with the highest rate of return to preinjury performance found in athletes in handball and sports with splits (fencing, squash, and escalade; 100%) and soccer (95.2%). In the univariate analysis, male sex (hazard ratio [HR], 4.05; 95% CI, 1.45-11.3; P = .008), higher preinjury TAS score (HR, 1.27; 95% CI, 1.06-1.52; P = .011), injury involving the semimembranosus (HR, 4.84; 95% CI, 2.31-10.2; P < .001) or conjoint tendon (HR, 3.12; 95% CI, 1.55-6.25; P = .001), and PHTR (HR, 7.77; 95% CI, 3.54-17.0; P < .001) were significantly associated with a better postoperative level of competition. Multivariate analysis identified 3 favorable predictors of RTS with HRs of 2.91 (95% CI, 1.01-8.35; P = .047) for male sex, 3.86 (95% CI, 1.78-8.37; P < .001) for isolated semimembranosus injury, and 5.18 (95% CI, 2.24-12.0; P < .001) for PHTR. The complication rate was 4.7%. CONCLUSION Favorable predictors of early RTS were male sex, isolated semimembranosus injury, and PHTR injuries. REGISTRATION NCT02906865 (ClinicalTrials.gov identifier).
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Markovic G, Karuc I. Backheel Pass During Forward Running as a Mechanism of Severe Acute Hamstring Injury in Football: A Case Report. Clin J Sport Med 2023; 33:569-570. [PMID: 37358314 DOI: 10.1097/jsm.0000000000001168] [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: 01/04/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
ABSTRACT Proximal hamstring tendon avulsions represent the most severe hamstring injury in sports and are typically sustained during stretch-related movements in closed kinetic chain: forced hip hyperflexion combined with knee extension. Here, we present the case study of the right-foot dominant professional football player with a severe proximal hamstring tendon avulsion injury and concomitant lower-grade injuries of hamstring muscle-tendon complex caused by a potentially new football-specific injury mechanism: right-foot backheel pass during forward running (ie, a kick directly backward). This mechanism involves a specific stretch-shortening cycle action of hamstring muscles in open-kinetic chain movement that has not yet been described in the scientific literature. Although further studies related to this football-specific hamstring injury mechanism are needed, clinicians and coaches working in football should be aware of it and potentially introduce additional injury mechanism-specific exercises and strategies for prevention of severe hamstring injuries which often require surgical intervention.
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Affiliation(s)
- Goran Markovic
- Motus Melior, Sports & Rehabilitation Clinic, Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia; and
- Faculty of Health Sciences, Primorska University, Izola, Slovenia
| | - Ivan Karuc
- Motus Melior, Sports & Rehabilitation Clinic, Zagreb, Croatia
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Gattringer M, Schalamon G, Pichler H, Breulmann FL, Buerger H, Mattiassich G, Bischofreiter M. Sciatic Nerve Compression after a Chronic Proximal Hamstring Tear: A Report of Two Cases and a Narrative Review of the Literature. Life (Basel) 2023; 13:1762. [PMID: 37629619 PMCID: PMC10455575 DOI: 10.3390/life13081762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Proximal hamstring tears are among the most common injuries afflicting athletes and middle-aged individuals. Sciatic nerve compression after a proximal hamstring injury, which can occur due to scar formation and subsequent irritation or compression of the nerve, is an infrequent but severe complication with few cases documented in the literature. No evidence is available about the optimal treatment for sciatic nerve symptoms after proximal hamstring injuries. In this case report, we present two cases involving patients primarily treated conservatively at another institution after suffering from a proximal hamstring injury and developing sciatic nerve symptoms over the course of a few months. Both were treated with open neurolysis at our institution without reattachment of the ruptured muscles to the ischial tuberosity due to the chronicity of the injuries. Both patients exhibited neurological symptoms over two years, which recovered after surgery. These two cases show that neurolysis of the sciatic nerve without reattachment of the proximal hamstring muscles is an applicable option for the treatment of chronic proximal hamstring tears with sciatic nerve compression. Further studies will be needed to validate this hypothesis.
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Affiliation(s)
- Michael Gattringer
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Georg Schalamon
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Hannes Pichler
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Franziska Lioba Breulmann
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Heinz Buerger
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Martin Bischofreiter
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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Lin KM, Atzmon R, Pierre KJ, Vel MS, Brinson K, Sherman SL. Common Soft Tissue Injuries About the Knee in American Football. HSS J 2023; 19:330-338. [PMID: 37435123 PMCID: PMC10331270 DOI: 10.1177/15563316231165298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Kenneth M Lin
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Ran Atzmon
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kinsley J Pierre
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Monica S Vel
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kenneth Brinson
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Seth L Sherman
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
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Looney AM, Day HK, Comfort SM, Donaldson ST, Cohen SB. Proximal Hamstring Ruptures: Treatment, Rehabilitation, and Return to Play. Curr Rev Musculoskelet Med 2023; 16:103-113. [PMID: 36757628 PMCID: PMC9943812 DOI: 10.1007/s12178-023-09821-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE OF REVIEW To assess the current literature surrounding the treatment and rehabilitation strategies surrounding proximal hamstring rupture injuries, along with comparative return to sport and patient-reported outcomes. RECENT FINDINGS A high degree of variability exists in protective and rehabilitation strategies after both operative and non-operative proximal hamstring rupture management. Acceptable outcomes after both operative and non-operative management have been observed but may vary greatly with injury chronicity, severity, and surgical technique. The high complication rates observed after surgical treatment, along with poor functional outcomes that may occur in the setting of non-operative treatment or delayed surgery, highlight the importance of early injury evaluation and careful patient selection. Further high-quality research elucidating clearer indications for early operative management and an optimized and standardized rehabilitation protocols may improve outcomes and return to sport experience and metrics for individuals sustaining proximal hamstring ruptures.
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Affiliation(s)
- Austin M. Looney
- The Rothman Orthopaedic Institute, Sports Medicine Division, 925 Chestnut St Fl 5, Philadelphia, PA 19107-4216 USA
| | - Hannah K. Day
- School of Medicine, Georgetown University, Washington, DC USA
| | | | | | - Steven B. Cohen
- The Rothman Orthopaedic Institute, Sports Medicine Division, 925 Chestnut St Fl 5, Philadelphia, PA 19107-4216 USA
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