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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2023; 64(01): e58-e68
DOI: 10.1055/s-0043-1768241
Artículo de Revisión | Review Article

Proximal Hamstring Avulsions, from Diagnosis to Treatment: A Review Regarding a Clinical Case

Article in several languages: español | English
Miguel Carrasco
1   Departamento de Traumatología, Clínica Alemana de Santiago, Santiago, Chile
2   Universidad del Desarrollo, Santiago, Chile
,
Diego Edwards 
1   Departamento de Traumatología, Clínica Alemana de Santiago, Santiago, Chile
2   Universidad del Desarrollo, Santiago, Chile
3   Hospital La Florida, Santiago, Chile
,
Consuelo Carrasco
4   Universidad Los Andes, Santiago, Chile
,
Gerardo Zelaya
3   Hospital La Florida, Santiago, Chile
,
Andrés Schmidt-Hebbel 
1   Departamento de Traumatología, Clínica Alemana de Santiago, Santiago, Chile
2   Universidad del Desarrollo, Santiago, Chile
,
Sebastián Bianchi
2   Universidad del Desarrollo, Santiago, Chile
› Author Affiliations Funding The present research did not receive any specific grants from the public, private or not-for-profit sectors.
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Abstract

Proximal hamstring avulsion is a rare injury that can produce permanent functional alterations, in addition to a high risk of retear (in up to 30% of the cases). It usually occurs in athletes who perform rapid accelerations or require ballistic movements during their training, although they also occur in a more sedentary population due to low-energy mechanisms. The most frequent mechanism of injury is an eccentric contraction of the proximal hamstrings when trying to resist a fall, with the hip in flexion and the knee in extension.

Numerous clinical signs are described at the physical examination. Regarding its study, although conventional radiography and ultrasound are very useful, magnetic resonance is recognized as the gold standard for its precise diagnosis.

Treatment will depend on the type of patient and their expectations, although in recent years the surgical option has been increasingly considered in cases of complete avulsion of the hamstrings associated with retraction.

We herein present a review of the topic in relation to a clinical case that was resolved surgically, and we discuss the basic concepts, clinical presentation, complementary images, and treatment options that are currently available.

Keywords

avulsion lesions - proximal hamstring - surgical treatment of proximal hamstring avulsions - hamstring rehabilitation


Publication History

Received: 08 June 2022

Accepted: 07 March 2023

Article published online:
18 May 2023

© 2023. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referencias

  • 1 Ishikawa K, Kai K, Mizuta H. Avulsion of the hamstring muscles from the ischial tuberosity. A report of two cases. Clin Orthop Relat Res 1988; (232) 153-155
    PubMedSearch in Google Scholar
  • 2 Chakravarthy J, Ramisetty N, Pimpalnerkar A, Mohtadi N. Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature. Br J Sports Med 2005; 39 (08) 569-572
    CrossrefPubMedSearch in Google Scholar
  • 3 Croisier JL. Factors associated with recurrent hamstring injuries. Sports Med 2004; 34 (10) 681-695
    CrossrefPubMedSearch in Google Scholar
  • 4 Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 2003; 32 (10) 582-589
    CrossrefPubMedSearch in Google Scholar
  • 5 Stępień K, Śmigielski R, Mouton C, Ciszek B, Engelhardt M, Seil R. Anatomy of proximal attachment, course, and innervation of hamstring muscles: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 673-684
    CrossrefPubMedSearch in Google Scholar
  • 6 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 (01) 44-48
    CrossrefPubMedSearch in Google Scholar
  • 7 Irger M, Willinger L, Lacheta L, Pogorzelski J, Imhoff AB, Feucht MJ. Proximal hamstring tendon avulsion injuries occur predominately in middle-aged patients with distinct gender differences: epidemiologic analysis of 263 surgically treated cases. Knee Surg Sports Traumatol Arthrosc 2020; 28 (04) 1221-1229
    CrossrefPubMedSearch in Google Scholar
  • 8 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) 2841-2851
    CrossrefPubMedSearch in Google Scholar
  • 9 Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998; 6 (04) 237-248
    CrossrefPubMedSearch in Google Scholar
  • 10 Bertiche P, Mohtadi N, Chan D, Hölmich P. Proximal hamstring tendon avulsion: state of the art. J ISAKOS 2021; 6 (04) 237-246
    CrossrefPubMedSearch in Google Scholar
  • 11 Degen RM. Proximal hamstring injuries: management of tendinopathy and avulsion injuries. Curr Rev Musculoskelet Med 2019; 12 (02) 138-146
    CrossrefPubMedSearch in Google Scholar
  • 12 Wilson TJ, Spinner RJ, Mohan R, Gibbs CM, Krych AJ. Sciatic nerve injury after proximal hamstring avulsion and repair. Orthop J Sports Med 2017; 5 (07) 2325967117713685
    CrossrefPubMedSearch in Google Scholar
  • 13 Ali K, Leland JM. Hamstring strains and tears in the athlete. Clin Sports Med 2012; 31 (02) 263-272
    CrossrefPubMedSearch in Google Scholar
  • 14 Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics 2005; 25 (03) 571-586
    CrossrefPubMedSearch in Google Scholar
  • 15 Mariani C, Caldera FE, Kim W. Ultrasound versus magnetic resonance imaging in the diagnosis of an acute hamstring tear. PM R 2012; 4 (02) 154-155
    CrossrefPubMedSearch in Google Scholar
  • 16 Wood DG, Packham I, Trikha SP, Linklater J. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 2008; 90 (11) 2365-2374
    CrossrefPubMedSearch in Google Scholar
  • 17 Shambaugh BC, Olsen JR, Lacerte E, Kellum E, Miller SL. A comparison of Nonoperative and operative treatment of complete proximal hamstring ruptures. Orthop J Sports Med 2017; 5 (11) 2325967117738551
    CrossrefPubMedSearch in Google Scholar
  • 18 Bodendorfer BM, Curley AJ, Kotler JA. 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) 2798-2808
    CrossrefPubMedSearch in Google Scholar
  • 19 Cohen SB, Rangavajjula A, Vyas D, Bradley JP. Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 2012; 40 (09) 2092-2098
    CrossrefPubMedSearch in Google Scholar
  • 20 Pihl E, Skoldenberg O, Nasell H, Jonhagen S, Kelly Pettersson P, Hedbeck CJ. Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients. BMJ Open Sport Exerc Med 2019; 5 (01) e000511
    CrossrefPubMedSearch in Google Scholar
  • 21 Harris JD, Griesser MJ, Best TM, Ellis TJ. Treatment of proximal hamstring ruptures - a systematic review. Int J Sports Med 2011; 32 (07) 490-495
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007; 15 (06) 350-355
    CrossrefPubMedSearch in Google Scholar
  • 23 Sallay PI, Ballard G, Hamersly S, Schrader M. Subjective and functional outcomes following surgical repair of complete ruptures of the proximal hamstring complex. Orthopedics 2008; 31 (11) 1092
    PubMedSearch in Google Scholar
  • 24 Mendiguchia J, Alentorn-Geli E, Brughelli M. Hamstring strain injuries: are we heading in the right direction?. Br J Sports Med 2012; 46 (02) 81-85
    Search in Google Scholar
  • 25 Factor S, Khoury A, Atzmon R, Vidra M, Amar E, Rath E. Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes. J Hip Preserv Surg 2021; 7 (04) 721-727
    CrossrefPubMedSearch in Google Scholar
  • 26 Domb BG, Linder D, Sharp KG, Sadik A, Gerhardt MB. Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2013; 2 (01) e35-e39
    CrossrefPubMedSearch in Google Scholar
  • 27 Laskovski JR, Kahn AJ, Urchek RJ, Guanche CA. Endoscopic proximal hamstring repair and ischial bursectomy using modified portal placement and patient positioning. Arthrosc Tech 2018; 7 (11) e1071-e1078
    CrossrefPubMedSearch in Google Scholar
  • 28 Moatshe G, Chahla J, Vap AR. et al. Repair of Proximal Hamstring Tears: A Surgical Technique. Arthrosc Tech 2017; 6 (02) e311-e317
    CrossrefPubMedSearch in Google Scholar
  • 29 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) 2933-2947
    CrossrefPubMedSearch in Google Scholar
  • 30 Ibañez F, Galan H, Milanesio E. et al. Avulsión proximal de tendones isquiotibiales: tratamiento quirúrgico en deportistas de alto rendimiento. Reporte de caso. Rev Asoc Argent Traumatol del Deporte. 2015; 22 (01) 49-56
    PubMedSearch in Google Scholar
  • 31 Birmingham P, Müller 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) 1819-1826
    CrossrefPubMedSearch in Google Scholar
  • 32 Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 1996; 24 (02) 130-136
    CrossrefPubMedSearch in Google Scholar
  • 33 Sandmann GH, Hahn D, Amereller M. et al. Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair. Int J Sports Med 2016; 37 (07) 570-576
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Lutz PM, Knörr M, Geyer S, Imhoff AB, Feucht MJ. Delayed proximal hamstring tendon repair after ischial tuberosity apophyseal fracture in a professional volleyball athlete: a case report. BMC Musculoskelet Disord 2021; 22 (01) 578
    CrossrefPubMedSearch in Google Scholar
  • 35 Hamming MG, Philippon MJ, Rasmussen MT. et al. Structural properties of the intact proximal hamstring origin and evaluation of varying avulsion repair techniques: an in vitro biomechanical analysis. Am J Sports Med 2015; 43 (03) 721-728
    CrossrefPubMedSearch in Google Scholar