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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(03): s00451810038
DOI: 10.1055/s-0045-1810038
Technical Note

Surgical Repair of Proximal Hamstring Tendon Avulsion

Reparo cirúrgico da avulsão tendínea proximal dos isquiotibiais
Guilherme Guadagnini Falotico 
1   Hip Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Bruno Francesco Scatigna 
1   Hip Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Financial Support The authors declare that they did not receive financial support from agencies in the public, private or non-profit sectors to conduct the present study.
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Abstract

Injuries to the proximal hamstring muscle complex are common in athletes and range from strains to tendinous and bony avulsions. The lesion mechanism typically involves an eccentric contraction of the hamstring muscles during abrupt hip hyperflexion with the knee in extension. Low-speed injuries occur in high kicks and splits, whereas tendon avulsions are common in high-speed activities, such as running and ballet. Clinically, patients present with pain, subcutaneous hematoma, and, sometimes, a palpable defect. Additional signs include limited knee extension and involvement of the sciatic nerve. Diagnosis relies on ultrasonography, magnetic resonance imaging (MRI), and radiography, and MRI is the standard test. Surgical treatment is indicated for complete avulsions, especially in athletes, to prevent loss of strength and difficulty in returning to sports. In the surgical technique herein described, we perform one or two transverse incisions in the gluteal fold, depending on the tendon retraction, followed by fixation with metal anchors. The postoperative period includes initial restriction, followed by accelerated rehabilitation for return to sports by the twelfth week. Since 2019, the technique has been applied to 13 patients, demonstrating good outcomes, without re-ruptures and a postoperative Tegner score similar to the preoperative one.

Resumo

As lesões do complexo dos músculos isquiotibiais proximais são frequentes em atletas e variam de distensões a avulsões tendíneas e ósseas. O mecanismo de lesão geralmente envolve contração excêntrica dos isquiotibiais durante hiperflexão abrupta do quadril com o joelho estendido. Lesões de baixa velocidade ocorrem em chutes altos e espacates, ao passo que avulsões tendíneas são comuns em atividades de alta velocidade, como corrida e balé. Clinicamente, os pacientes apresentam dor, hematoma subcutâneo e, em alguns casos, defeito palpável. Sinais adicionais incluem limitação na extensão do joelho e comprometimento do nervo ciático. O diagnóstico é feito por ultrassonografia, ressonância magnética (RM) e radiografia, sendo a RM o exame padrão. O tratamento cirúrgico é indicado para avulsões completas, especialmente em atletas, e visa evitar perda de força e dificuldades no retorno ao esporte. A técnica cirúrgica aqui descrita utiliza uma ou duas incisões transversais na prega glútea, dependendo da retração do tendão, com fixação por âncoras metálicas. O pós-operatório inclui restrição inicial, seguida de reabilitação acelerada para retorno ao esporte a partir da décima segunda semana. Desde 2019, a técnica foi aplicada em 13 pacientes, e demonstrou bons resultados sem rerrupturas, com pontuação pós-operatória no escore de Tegner semelhante à do pré-operatório.

Keywords

hamstring muscle - hamstring tendons - tendon injury

Palavras-chave

lesões dos tendões - músculos isquiossurais - tendões dos músculos isquiotibiais

Authors' Contributions

Each author contributed individually and significantly to the development of the present article. BFS: validation, visualization, writing – original draft, and writing – review & editing; and GGF: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – original draft, andwriting – review & editing.


Study developed at the Hip Group of the Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.




Publication History

Received: 26 February 2025

Accepted: 22 May 2025

Article published online:
08 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Guilherme Guadagnini Falotico, Bruno Francesco Scatigna. Surgical Repair of Proximal Hamstring Tendon Avulsion. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451810038.
DOI: 10.1055/s-0045-1810038