Proximal hamstring tendon avulsion: state of the art

2020 ◽  
pp. jisakos-2019-000420
Author(s):  
Pablo Bertiche ◽  
Nicholas Mohtadi ◽  
Denise Chan ◽  
Per Hölmich
Keyword(s):  
Surgical Treatment ◽  
State Of The Art ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Biceps Femoris ◽  
Hamstring Tendon ◽  
Ischial Tuberosity ◽  
Patient Reported ◽  
Proximal Hamstring ◽  
Non Surgical Treatment

Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.

scholarly journals Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients

2019 ◽  
Vol 5 (1) ◽  
pp. e000511 ◽  
Author(s):  
Elsa Pihl ◽  
Olof Skoldenberg ◽  
Hans Nasell ◽  
Sven Jonhagen ◽  
Paula Kelly Pettersson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Hamstring Injury ◽  
Middle Aged ◽  
Mri Findings ◽  
Aged Patients ◽  
Patient Reported ◽  
Proximal Hamstring ◽  
Non Surgical Treatment

ObjectivesIn the literature on proximal hamstring avulsions, only two studies report the outcomes of non-surgically treated patients. Our objective was to compare subjective recovery after surgical and non-surgical treatment of proximal hamstring avulsions in a middle-aged cohort.MethodsWe included 47 patients (33 surgically and 14 non-surgically treated) with a mean (SD) age of 51 (±9) years in a retrospective cohort study. Follow-up time mean (SD) of 3.9 (±1.4) years. The outcome variables were the Lower Extremity Functional Scale (LEFS) and questions from the Proximal Hamstring Injury Questionnaire. Outcome variables were adjusted in regression models for gender, age, American Society of Anestesiologits (ASA) classification and MRI findings at diagnosis.ResultsThe baseline characteristics showed no differences except for the MRI result, in which the surgically treated group had a larger proportion of tendons retracted ≥ 2 cm. The mean LEFS score was 74 (SD±12) in the surgically treated cohort and 72 (SD±16) in the non-surgically treated cohort. This was also true after adjusting for confounders. The only difference in outcome at follow-up was the total hours performing physical activity per week, p=0.02; surgically treated patients reported 2.5 hours or more (5.2 vs 2.7).ConclusionThis study on middle-aged patients with proximal hamstring avulsions was unable to identify any difference in patient-reported outcome measures between surgically and non-surgically treated patients. The vast majority of patients treated surgically had complete proximal hamstring avulsions with ≥ 2 cm of retraction. We conclude that to obtain an evidence-based treatment algorithm for proximal hamstring avulsions studies of higher scientific level are needed.

scholarly journals Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110430
Author(s):  
Raymond Best ◽  
Anorte Meister ◽  
Malin Meier ◽  
Jochen Huth ◽  
Ulrich Becker
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Predictive Factors ◽  
Hamstring Tendon ◽  
Patient Reported ◽  
Duration Of Surgery ◽  
The Mean ◽  
Concomitant Factors ◽  
Proximal Hamstring ◽  
Tendon Avulsion

Background: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge. Purpose/Hypothesis: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient’s functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery. Results: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores ( P = .003; r = –0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores ( P = .525; r = –0.06). Conclusion: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.

Dupuytren’s disease

2011 ◽  
Author(s):  
Peter Burge
Keyword(s):  
Surgical Treatment ◽  
Steroid Injection ◽  
Treatment Options ◽  
Genetic Component ◽  
Dupuytren’S Disease ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Collagenase Injection ◽  
Operative Complications ◽  
Non Surgical Treatment

♦ Dupuytren’s disease is characterised by contracture of a finger resulting from thickening and shortening of the palmar fascia♦ A genetic component to the aetiology is apparent, smoking, alcohol and diabetes can increase the risk♦ The pathogenesis of Dupuytren’s disease remains elusive♦ Non-surgical treatment options include splintage, steroid injection and collagenase injection♦ Surgery cannot cure the disease but can straighten bent digits and minimize recurrence♦ Operative methods can be considered with regards to incision, management of the diseased fascia and closure techniques♦ Operative complications include injury of digital nerves and arteries

scholarly journals Case Report: Abomasum Impaction in Beef Cattle Due to High Intake of Distillers' Grain and Treatment Options in Southwest China

2021 ◽  
Vol 8 ◽  
Author(s):  
Kang Yong ◽  
Zhengzhong Luo ◽  
Qinwen Yang ◽  
Chuanshi Zhang ◽  
Qianlan Zhou ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Beef Cattle ◽  
Southern China ◽  
Treatment Options ◽  
Treatment Success ◽  
Solid Content ◽  
High Intake ◽  
Surgical Options ◽  
Distillers Grain ◽  
Non Surgical Treatment

In Southern China, distillers' grain is the main feed ingredient for small beef cattle farms. High intake of distillers' grain may lead to abomasum impaction, a disorder caused by the accumulation of solid content within the organ. For treatment, there are non-surgical and surgical options. In this study, we aimed to describe the clinical presentation, diagnosis, and treatment of beef cattle with abomasum impaction due to high intake of distillers' grain. Forty-nine Simmental beef cattle from 13 farms in Chongqing, China, were diagnosed with abomasum impaction. Animals were male, aged ≤2 years, and weighed between 200 and 350 kg. In this retrospective study, information on distillers' grain intake and clinical data were collected for 49 beef cattle diagnosed with abomasum impaction. The animals were treated between 2011 and 2019 with either non-surgical therapy or surgery. Animals diagnosed with mild abomasum impaction (n = 14) fully recovered after non-surgical treatment. Among moderate cases (n = 19), 12 cattle recovered after non-surgical treatment (63%), while the remaining seven did not respond well and underwent surgery. Three of those animals were subsequently cured (3/7). Among the severe cases (n = 16), four cattle were cured after non-surgical treatment (25%) (4/16). Of the remaining 12 cattle, six were slaughtered, and six died after surgery. Non-surgical treatment is efficient for mild abomasum impaction caused by a high intake of distillers' grain and may be considered for both moderate and severe cases. However, the treatment success rate for more severe cases decreases as the disease severity worsens.

Patient-reported Outcome Measures for Women with Vulvar Neoplasia – Current Situation and Future Directions

2013 ◽  
Vol 09 (02) ◽  
pp. 110
Author(s):  
Beate Senn ◽  
Manuela Eicher ◽  
Michael D Mueller ◽  
Sandra Engberg ◽  
Rebecca Spirig ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Intraepithelial Neoplasia ◽  
Patient Reported Outcome Measures ◽  
Evidence Base ◽  
Patient Reported Outcome ◽  
Self Report ◽  
Vulvar Intraepithelial Neoplasia ◽  
Research Project ◽  
Patient Reported

This article discusses concerns about women with vulvar neoplasia (vulvar intraepithelial neoplasia and vulvar cancer) and the available surgical treatment options. Given the gaps in the evidence base in terms of women with vulvar neoplasia and surgical treatment the women with vulvar Neoplasia-Patient Reported Outcome (WOMAN-PRO) research project focused on complications, symptoms and associated distress of women with surgically treated vulvar neoplasia. The main results of the research project are summarised, showing complications identified by clinicians, experiences reported by patients, the newly developed WOMAN-PRO instrument and symptom occurrence of each of 31 symptoms and the degree to which symptoms distressed women during the first seven days after discharge following surgical treatment for their vulvar neoplasia. Furthermore, based on the major findings of the project, suggestions for further research and clinical practice and conclusions are presented. We conclude that including patient self-report as a major element in follow-up care has the potential to enhance the quality of supportive care.

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