Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes

Downloaded from ojs.sagepub.com by guest on October Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes 0 Ge ́ n e ́rale de Sante ́ , Hoˆ pital prive ́ Jean Mermoz; Centre Orthope ́ dique Santy, FIFA Medical Center of Excellence , Lyon , France 1 de Sante ́ , Hoˆ pital prive ́ Jean Mermoz; Centre Orthope ́ dique Santy, FIFA @aol.com) 2 Kansas City University , Kansas City, Missouri , USA 3 Bertrand Sonnery-Cottet Background: Hamstring injury is the most common muscular lesion in athletes. The conservative treatment is well described, and surgical management is often indicated for proximal tendinous avulsions. To our knowledge, no surgical treatment has been proposed for failure of conservative treatment in musculotendinous hamstring lesions. Purpose: To describe the surgical management of proximal and distal hamstring musculotendinous junction lesions in professional athletes after failure of conservative treatment. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of 10 professional athletes, including 4 soccer players, 4 rugby players, and 2 handball players, underwent surgical intervention between October 2010 and June 2014 for the treatment of recurrent musculotendinous hamstring injuries. All athletes had failed at least 3 months of conservative treatment for a recurrent musculotendinous hamstring injury. Surgical resection of the musculotendinous scar tissue was performed using a longitudinal muscular suture. Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at the 3-month follow-up, and a final phone interview was completed to determine recurrence of hamstring injury and return to previous level of play. Results: The mean age at surgery was 25.2 years (range, 19-35 years). The musculotendinous hamstring lesions involved 8 semitendinosus and 2 biceps femoris, with 6 injuries located proximally and 4 distally. Conservative treatment lasted a mean 5.1 months (range, 3-9 months) after last recurrence, and the patients had an average of 2.7 (range, 2-5) separate incidents of injury recurrence before surgical intervention was decided upon. At the 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. All 10 patients returned to the same level of play at a mean 3.4 months (range, 2-5 months). At a mean follow-up of 28.7 months, none of the athletes had suffered a recurrence. No surgical complication was encountered. Conclusion: In cases of failed conservative treatment of musculotendinous hamstring lesions, surgical intervention may be a viable treatment option in professional athletes and allows the patient to return to the same level of play. hamstring; musculotendinous lesion; sports injuries; professional athlete - One or more of the authors has declared the following potential conflict of interest or source of funding: B.S-C. and M.T. are paid consultants for Arthrex. Historically, the term hamstring is derived from the trade of butchering. Pig carcasses were hung up by these tendinous muscles in the thigh of the ham for slaughtering. Additionally, the verb to hamstring means ‘‘to disable or to render useless.’’ This is testament to the importance of the hamstrings in both daily life and recreational activities.30 The hamstrings are made up of 3 separate muscles: the semimembranosus, semitendinosus, and biceps femoris, the latter with a long and short head. The tendon of origin of the semimembranosus muscle arises from the triangular lateral facet of the ischial tuberosity; yet just below the tuberosity it has the form of a flat band, which lies in the coronal plane, on the deep aspect of the biceps and semitendinosus. The biceps femoris and semitendinosus share This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/ licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Surgical Outcomesa Patient Sex Age, y Side Location Months From First Injury to Surgery Months From Surgery Follow-up, to Return to Play mo aBF, biceps femoris; L, left; M, male; R, right; ST, semitendinosus. a common tendon of origin, which arises from the medial facet of the ischial tuberosity.26 The hamstring spans both the hip and knee joints. During certain activities, these 2 joints may be moving in opposite directions, which contributes to a predisposition to an eccentric injury. In addition, the hamstrings have more abundant type II muscle fibers, which give explosive force compared with the quadriceps but may further predispose the hamstrings to injury.34 Hamst (...truncated)