Surgical Variants in the Treatment of Proximal Hamstring Avulsion
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Published:
Jun 15, 2021
Keywords:
Hamstrings, surgical treatment, functional outcome, sports
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Abstract
Proximal tendon avulsion of the hamstring insertion is a rare entity. The therapeutic approach is different in contrast to the treatment in common muscle tears. The greater benefit of surgical treatment has been widely verified in the literature, and given the low frequency of this type of injury, few orthopedic surgeons are used to both diagnosis and surgical procedures in this anatomical region. The aim of this article is to report four patients with insertional hamstring rupture and describe the surgical technique used in each case. We present the surgical variants as well as the outcomes achieved.
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How to Cite
De Cicco, F. L., Holc, F., Sánchez Saba, J. E., Taype Zamboni, D., Barla, J., Sancineto, C., & Carabelli, G. (2021). Surgical Variants in the Treatment of Proximal Hamstring Avulsion. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(3), 407-416. https://doi.org/10.15417/issn.1852-7434.2021.86.3.1105
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Case Presentations
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References
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https://doi.org/10.1177/0363546514555327
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11. 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(12):1022-5. https://doi.org/10.2106/JBJS.M.01074
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14. de Hoyo M, Naranjo-Orellana J, Carrasco L, Sañudo B, Jiménez Barroca JJ, Domínguez-Cobo S. Revisión sobre
la lesión de la musculatura isquiotibial en el deporte: factores de riesgo y estrategias para su prevención. Rev Andal Med Deporte 2013;6(1):30-7. https://doi.org/10.1016/S1888-7546(13)70032-7
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surgical technique. Arthrosc Tech 2017;6(2):e311-7. https://doi.org/10.1016/j.eats.2016.10.004
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2008;90(11):2365-74. https://doi.org/10.2106/JBJS.G.00685
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remodeling following a hamstring strain injury. Skeletal Radiol 2008;37(12):1101-9.
https://doi.org/10.1007/s00256-008-0546-0
21. Matsuda DK. Editorial commentary: proximal hamstring syndrome: another pain in the buttock. Arthroscopy
2018;34(1):122-5. https://doi.org/10.1016/j.arthro.2017.08.260
22. Harris JD, Griesser MJ, Best TM, Ellis TJ. Treatment of proximal hamstring ruptures - a systematic review. Int J
Sports Med 2011;32(7):490-5. https://doi.org/10.1055/s-0031-1273753
23. Piposar JR, Vinod AV, Olsen JR, Lacerte E, Miller SL. High-grade partial and retracted (<2 cm) proximal hamstring ruptures: nonsurgical treatment revisited. Orthop J Sports Med 2017;5(2):2325967117692507.
https://doi.org/10.1177/2325967117692507
24. Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R. Functional outcome after repair of
proximal hamstring avulsions. J Bone Joint Surg Am 2011;93(19):1819-26. https://doi.org/10.2106/JBJS.J.01372
25. Orava S, Kujala UM. Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 1995;23(6):702-5.
https://doi.org/10.1177/036354659502300612
1998;6(4):237-48. https://doi.org/10.5435/00124635-199807000-00005
2. Ali K, Leland JM. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31(2):263-72.
https://doi.org/10.1016/j.csm.2011.11.001
3. Johnson AE, Granville RR, DeBerardino TM. Avulsion of the common hamstring tendon origin in an active duty
airman. Mil Med 2003;168(1):40-2. https://doi.org/10.1093/milmed/168.1.40
4. 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(4):394-9. https://doi.org/10.1308/003588407X183427
5. Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007;15(6):350-5.
https://doi.org/10.5435/00124635-200706000-00004
6. van der Made AD, Reurink G, Gouttebarge V, Tol JL, Kerkhoffs GM. Outcome after surgical repair of proximal
hamstring avulsions: A systematic review. Am J Sports Med 2015;43(11):2841-51.
https://doi.org/10.1177/0363546514555327
7. Blakeney WG, Zilko SR, Edmonston SJ, Schupp NE, Annear PT. A prospective evaluation of proximal hamstring
tendon avulsions: improved functional outcomes following surgical repair. Knee Surg Sports Traumatol Arthrosc
2017;25(6):1943-50. https://doi.org/10.1007/s00167-017-4475-0
8. Bodendorfer BM, Curley AJ, Kotler JA, Ryan JM, Jejurikar NS, Kumar A, et al. Outcomes after operative and
nonoperative treatment of proximal hamstring avulsions: a systematic review and meta-analysis. Am J Sports Med 2018;46(11):2798-808. https://doi.org/10.1177/0363546517732526
9. Miller SL, Gill J, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am 2007;89(1):44-8. https://doi.org/10.2106/JBJS.F.00094
10. Bowman KF, Cohen SB, Bradley JP. Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 2013;41(6):1363-71. https://doi.org/10.1177/0363546513482717
11. 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(12):1022-5. https://doi.org/10.2106/JBJS.M.01074
12. Puranen J, Orava S. The hamstring syndrome. A new diagnosis of gluteal sciatic pain. Am J Sports Med
1988;16(5):517-21. https://doi.org/10.1177/036354658801600515
13. Ahmad CS, Redler LH, Ciccotti MG, Maffulli N, Longo UG, Bradley J. Evaluation and management of hamstring
injuries. Am J Sports Med 2013;41(12):2933-47. https://doi.org/10.1177/0363546513487063
14. de Hoyo M, Naranjo-Orellana J, Carrasco L, Sañudo B, Jiménez Barroca JJ, Domínguez-Cobo S. Revisión sobre
la lesión de la musculatura isquiotibial en el deporte: factores de riesgo y estrategias para su prevención. Rev Andal Med Deporte 2013;6(1):30-7. https://doi.org/10.1016/S1888-7546(13)70032-7
15. Moatshe G, Chahla J, Vap AR, Ferrari M, Sanchez G, Mitchell JJ, et al. Repair of proximal hamstring tears: A
surgical technique. Arthrosc Tech 2017;6(2):e311-7. https://doi.org/10.1016/j.eats.2016.10.004
16. Linklater JM, Hamilton B, Carmichael J, Orchard J, Wood DG. Hamstring injuries: anatomy, imaging, and
intervention. Semin Musculoskelet Radiol 2010;14(2):131-61. https://doi-org/10.1055/s-0030-1253157
17. Davis KW. Imaging of the hamstrings. Semin Musculoskelet Radiol 2008;12(1):28-41.
https://doi.org/10.1055/s-2008-1067935
18. Wood DG, Packham I, Trikha SP, Linklater J. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am
2008;90(11):2365-74. https://doi.org/10.2106/JBJS.G.00685
19. Guanche CA. Hamstring injuries. J Hip Preserv Surg 2015;2(2):116-22. https://doi.org/10.1093/jhps/hnv026
20. Silder A, Heiderscheit BC, Thelen DG, Enright T, Tuite MJ. MR observations of long-term musculotendon
remodeling following a hamstring strain injury. Skeletal Radiol 2008;37(12):1101-9.
https://doi.org/10.1007/s00256-008-0546-0
21. Matsuda DK. Editorial commentary: proximal hamstring syndrome: another pain in the buttock. Arthroscopy
2018;34(1):122-5. https://doi.org/10.1016/j.arthro.2017.08.260
22. Harris JD, Griesser MJ, Best TM, Ellis TJ. Treatment of proximal hamstring ruptures - a systematic review. Int J
Sports Med 2011;32(7):490-5. https://doi.org/10.1055/s-0031-1273753
23. Piposar JR, Vinod AV, Olsen JR, Lacerte E, Miller SL. High-grade partial and retracted (<2 cm) proximal hamstring ruptures: nonsurgical treatment revisited. Orthop J Sports Med 2017;5(2):2325967117692507.
https://doi.org/10.1177/2325967117692507
24. Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R. Functional outcome after repair of
proximal hamstring avulsions. J Bone Joint Surg Am 2011;93(19):1819-26. https://doi.org/10.2106/JBJS.J.01372
25. Orava S, Kujala UM. Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 1995;23(6):702-5.
https://doi.org/10.1177/036354659502300612