scholarly journals A Novel Technique for Proximal Hamstring Tendon Repair: High Reoperation Rate in a Series of 56 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
William Blakeney ◽  
Simon Zilko ◽  
Wael Chiri ◽  
Peter Annear
Keyword(s):  
Functional Outcomes ◽  
Assessment Tool ◽  
Tendon Repair ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Reoperation Rate ◽  
Ischial Tuberosity ◽  
Novel Technique ◽  
Proximal Hamstring Rupture ◽  
Proximal Hamstring

This investigation looked at functional outcomes, following a novel technique of surgical repair using table staples. Patients underwent surgery for proximal hamstring rupture with table staples used to hold the tendon reapproximated to the ischial tuberosity. Functional outcomes following surgery were assessed. We also used a combined outcome assessment measure: the Perth Hamstring Assessment Tool (PHAT). A total of 56 patients with a mean age of 51 (range 15–71) underwent surgery. The mean follow-up duration was 26 months (range 8–59 months). A large proportion of patients (21/56, 37.5%) required reoperation for removal of the staple. Patients that did not require removal of the table staple did well postoperatively, with low pain scores (0.8–2 out of 10) and good levels of return to sport or running (75.8%). Those that required removal of the staple had a significantly lower PHAT score prior to removal, 47.8, but this improved markedly once the staple was removed, with a mean of 77.2 (P<0.001). Although our patients achieved similar outcomes in terms of pain and function, we thought the reoperation rate was unacceptably high. We would not recommend proximal hamstring tendon repair using this technique.

scholarly journals Delayed proximal hamstring tendon repair after ischial tuberosity apophyseal fracture in a professional volleyball athlete: a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Patricia M. Lutz ◽  
Michel Knörr ◽  
Stephanie Geyer ◽  
Andreas B. Imhoff ◽  
Matthias J. Feucht
Keyword(s):  
Tendon Repair ◽  
Hamstring Tendon ◽  
Ischial Tuberosity ◽  
Hamstring Tendons ◽  
Avulsion Fractures ◽  
Case Presentation ◽  
Bony Fragment ◽  
Open Excision ◽  
Proximal Hamstring ◽  
Suture Anchor Fixation

Abstract Background Ischial tuberosity apophyseal fractures are avulsion fractures of the anatomic footprint of the proximal hamstring tendons. Generally, these injuries are rare and frequently occur in skeletally immature, active patients due to incomplete ossification. Depending on the fragment displacement, non-operative or operative treatment approaches are used. Case presentation We report a case of a 29-year-old professional volleyball athlete who has suffered from a nonunion avulsion fracture for 14 years. Isolated suture anchor fixation was performed after open excision of a large bony fragment followed by excellent clinical and functional outcome at 1 year postoperatively. Conclusion In conclusion, avulsion fractures of the ischial tuberosity with large fragments and restrictions to activities of daily living due to pain can, in individualized cases, be treated with an open excision of the fragment followed by repair of the proximal hamstring tendons using suture anchors.

Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair

2016 ◽  
Vol 37 (07) ◽  
pp. 570-576 ◽  
Author(s):  
G. Sandmann ◽  
D. Hahn ◽  
M. Amereller ◽  
S. Siebenlist ◽  
A. Schwirtz ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Return To Sports ◽  
Proximal Hamstring

Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up

2019 ◽  
Vol 28 (4) ◽  
pp. 1230-1235 ◽  
Author(s):  
Lukas Willinger ◽  
Sebastian Siebenlist ◽  
Lucca Lacheta ◽  
Markus Wurm ◽  
Markus Irger ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Complication Rate ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Proximal Hamstring ◽  
Excellent Clinical Outcome

scholarly journals Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985321 ◽  
Author(s):  
John W. Belk ◽  
Matthew J. Kraeutler ◽  
Omer Mei-Dan ◽  
Darby A. Houck ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Proximal Hamstring

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

scholarly journals Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair

2016 ◽  
Vol 37 (07) ◽  
pp. e8-e8 ◽  
Author(s):  
G. Sandmann ◽  
D. Hahn ◽  
M. Amereller ◽  
S. Siebenlist ◽  
A. Schwirtz ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Return To Sports ◽  
Proximal Hamstring

scholarly journals Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875511 ◽  
Author(s):  
Harry M. Lightsey ◽  
David E. Kantrowitz ◽  
Hasani W. Swindell ◽  
David P. Trofa ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
United States ◽  
Range Of Motion ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Search Term ◽  
Postoperative Rehabilitation ◽  
Professional Literature ◽  
Rehabilitation Protocol ◽  
Rehabilitation Protocols ◽  
Proximal Hamstring

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training. Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.

Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool

2016 ◽  
Vol 25 (6) ◽  
pp. 1936-1942 ◽  
Author(s):  
William G. Blakeney ◽  
Simon R. Zilko ◽  
Steven J. Edmonston ◽  
Natalie E. Schupp ◽  
Peter T. Annear
Keyword(s):  
Assessment Tool ◽  
Hamstring Tendon ◽  
Proximal Hamstring ◽  
Tendon Avulsion

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 Endoscopic Repair of the Proximal Hamstring

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110038
Author(s):  
Steven F. DeFroda ◽  
Benjamin S. Kester ◽  
Alexander C. Newhouse ◽  
Daniel M. Wichman ◽  
Sunikom Suppaiksorn ◽  
...  
Keyword(s):  
Conservative Management ◽  
Open Repair ◽  
Perioperative Complications ◽  
Return To Sport ◽  
Ischial Tuberosity ◽  
Wound Complications ◽  
Endoscopic Repair ◽  
Endoscopic Techniques ◽  
Hamstring Injuries ◽  
Proximal Hamstring

Background: Proximal hamstring injuries are increasingly common. While open repair with suture anchors placed in the ischial tuberosity has long been the gold standard technique for surgical management, endoscopic techniques can allow for smaller incisions, reduced wound complications, and an expedited recovery. Indications: Patients with full-thickness 3-tendon proximal hamstring tears, 2-tendon tears with retraction >2 cm, or partial tears that remain symptomatic despite conservative management are considered for surgery. High-demand patients are often treated acutely, and low-demand patients may be offered surgery after a conservative management period. Technique Description: In the prone position, 2 arthroscopic portals are created in the gluteal fold. Fluoroscopy is used to verify safe portal placement, and the sciatic nerve is visualized along with the retracted tendon origin. The ischial tuberosity is identified, and the hamstring origin is debrided and decorticated. An accessory portal is created for suture anchor placement. Two double-loaded anchors are placed in the tuberosity, the sutures of which are used to repair the hamstring tendons using a horizontal mattress configuration. Patients undergo a stepwise postoperative physical therapy protocol. Results: An 85% return to sport rate can be expected following all hamstring repairs, with some studies reporting as high as 95% after endoscopic repair. Compared with nonoperative treatment, proximal hamstring repair overall results in higher patient satisfaction and return to sport. While large studies have yet to report on outcomes compared with the traditional open technique, the smaller incisions look to reduce wound complications and postoperative pain. Discussion/Conclusion: Recent advancements in endoscopic techniques have allowed for adequate visualization and robust repair of proximal hamstring avulsions. We present our endoscopic technique of the proximal hamstring, which, compared with the traditional open repair, can decrease perioperative complications and accelerate recovery.

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