Aktueller Stand zu Verletzungen der proximalen und distalen Hamstring-Sehnen

Zusammenfassung

Die ischiokrurale Muskulatur, auch Hamstring-Muskulatur genannt, überspannt sowohl das Hüft- als auch das Kniegelenk und erleidet während sportlicher Aktivitäten häufig Verletzungen. Sehnenverletzungen der Hamstring-Muskulatur sind eine seltenere Entität als die Verletzung der Muskulatur selbst.

Allerdings kann insbesondere die Avulsion der proximalen Hamstring-Sehnen zu immobilisierenden Beschwerden mit fortwährender Einschränkung der Sportfähigkeit führen. Entsprechend dem individuellen körperlichen und sportlichen Anspruch erfolgt die weiterführende Therapie dieser klinisch relevanten Verletzung. Im Rahmen der operativen Versorgung erfolgt eine Refixation der proximalen Hamstring-Sehnen am Tuber ischiadicum. Die operative Therapie zeigte eine signifikant höhere Patientenzufriedenheit sowie eine signifikant bessere Wiederherstellung der Sportfähigkeit als ein konservatives Vorgehen. Zudem konnten Vorteile für die akute gegenüber einer verzögerten operativen Versorgung beobachtet werden.

Rupturen der distalen Hamstring-Sehnen stellen eine noch seltenere Verletzung als die der proximalen Hamstring-Sehnen dar. Dabei sind vor allem Verletzungen der distalen M.-biceps-femoris- und M.-semimembranosus-Sehne von klinischer Relevanz. Die Ruptur der distalen M.-biceps-femoris-Sehne tritt vorwiegend im Rahmen von Multiligamentverletzungen des Kniegelenks auf. Jedoch ist die Literatur betreffend Verletzungen der distalen Hamstring-Sehnen, insbesondere isolierter Sehnenrupturen, nur auf Fallserien und Fallbeschreibungen limitiert.

Dieser Artikel bietet einen umfassenden Überblick über die Therapie von proximalen und distalen Rupturen der Hamstring-Sehnen.

Rupturen der proximalen Hamstring-Sehnen sind für Patienten mit körperlichem Anspruch von besonderer Relevanz, da sie zu einer relevanten funktionellen Einschränkung führen können. Rupturen der distalen Hamstring-Sehnen stellen eine seltene Sonderform von Verletzungen der ischiokruralen Muskulatur dar. Dieser Artikel bietet einen umfassenden Überblick über die Therapie von proximalen und distalen Rupturen der Hamstring-Sehnen.

Abstract

As biarticular muscles, the hamstring muscles span hip as well as the knee joint. The hamstring muscles are affected most by sports-related musculoskeletal injuries. However, avulsions of the hamstring muscle tendons are rare injuries.

Nevertheless, proximal hamstring tendon avulsions can lead to immobilizing complaints with constant physical limitations. Adequate therapy is chosen under consideration of the patients’ individual physical demands. For surgical repair, a reattachment of the tendons to the ischial tuberosity is performed. Surgical treatment resulted in significant higher patients’ satisfaction and return to sports as non-operative treatment. Furthermore, surgical treatment resulted in better clinical outcomes in acute than in chronic cases.

Avulsions of the distal hamstring tendons represent injuries that are even more rare than proximal hamstring avulsions. Especially, the distal biceps femoris tendon and the semimembranosus tendon are of clinical relevance. Multiligamentous knee injuries can often include lesions to the distal biceps femoris tendon as well. Unfortunately, the literature is limited to case series and case reports and does not provide a treatment algorithm for distal hamstring tendon injuries.

This article provides an overview for the treatment of proximal as well as distal hamstring avulsions.

Schlüsselwörter

proximale Hamstringsehnen - distale Hamstringsehnen - M. biceps femoris - M. semimembranosus - M. semitendinosus - Sehnenruptur - Therapie

Keywords

proximal hamstring tendons - distal hamstring tendons - M. biceps femoris tendon - M. semimembranosus - M. semitendinosus - tendon avulsion - treatment

Publication History

Article published online:
06 July 2023

• Literatur

• 1 Croisier JL. Factors associated with recurrent hamstring injuries. Sports Med 2004; 34: 681-695 DOI: 10.2165/00007256-200434100-00005. (PMID: 15335244)
• 2 Dalton SL, Kerr ZY, Dompier TP. Epidemiology of Hamstring Strains in 25 NCAA Sports in the 2009–2010 to 2013–2014 Academic Years. Am J Sports Med 2015; 43: 2671-2679 DOI: 10.1177/0363546515599631. (PMID: 26330571)
• 3 Heiderscheit BC, Sherry MA, Silder A. et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010; 40: 67-81 DOI: 10.2519/jospt.2010.3047. (PMID: 20118524)
• 4 Petersen J, Holmich P. Evidence based prevention of hamstring injuries in sport. Br J Sports Med 2005; 39: 319-323 DOI: 10.1136/bjsm.2005.018549. (PMID: 15911599)
• 5 Prior M, Guerin M, Grimmer K. An evidence-based approach to hamstring strain injury: a systematic review of the literature. Sports Health 2009; 1: 154-164 DOI: 10.1177/1941738108324962. (PMID: 23015867)
• 6 Ahmad CS, Redler LH, Ciccotti MG. et al. Evaluation and management of hamstring injuries. Am J Sports Med 2013; 41: 2933-2947 DOI: 10.1177/0363546513487063. (PMID: 23703914)
• 7 Brucker PU, Imhoff AB. Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2005; 13: 411-418 DOI: 10.1007/s00167-004-0563-z. (PMID: 15602681)
• 8 Irger M, Willinger L, Lacheta L. et al. 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: 1221-1229 DOI: 10.1007/s00167-019-05717-7. (PMID: 31541291)
• 9 Wood DG, Packham I, Trikha SP. et al. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 2008; 90: 2365-2374 DOI: 10.2106/JBJS.G.00685. (PMID: 18978405)
• 10 Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 2003; 32: 582-589 DOI: 10.1007/s00256-003-0674-5. (PMID: 12942206)
• 11 Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007; 15: 350-355 DOI: 10.5435/00124635-200706000-00004. (PMID: 17548884)
• 12 Guanche CA. Hamstring injuries. J Hip Preserv Surg 2015; 2: 116-122 DOI: 10.1093/jhps/hnv026. (PMID: 27011828)
• 13 van der Made AD, Reurink G, Gouttebarge V. et al. Outcome After Surgical Repair of Proximal Hamstring Avulsions: A Systematic Review. Am J Sports Med 2015; 43: 2841-2851 DOI: 10.1177/0363546514555327. (PMID: 25384502)
• 14 Blakeney WG, Thaunat M, Ouanezar H. et al. Distal Semimembranosus Tendon Avulsions: Acute Surgical Repair in a Professional Rugby Player. Orthop J Sports Med 2017; 5: 2325967117731102 DOI: 10.1177/2325967117731102. (PMID: 29051904)
• 15 Metcalf KB, Knapik DM, Voos JE. Damage to or Injury of the Distal Semitendinosus Tendon During Sporting Activities: A Systematic Review. HSS J 2019; 15: 185-189 DOI: 10.1007/s11420-018-9639-z. (PMID: 31327951)
• 16 Ahmed I, Williams M, Murray J. Investigation and management of an isolated complete distal avulsion of semitendinosus. BMJ Case Rep 2018; 2018: bcr2017222239 DOI: 10.1136/bcr-2017-222239. (PMID: 29666077)
• 17 Kelly T, Gultekin S, Cross T. et al. Distal Avulsion of the Semitendinosus Tendon: A Case Report. Orthop J Sports Med 2019; 7: 2325967119873843 DOI: 10.1177/2325967119873843. (PMID: 31598530)
• 18 Thompson JW, Plastow R, Kayani B. et al. Surgical Repair of Distal Biceps Femoris Avulsion Injuries in Professional Athletes. Orthop J Sports Med 2021; 9: 2325967121999643 DOI: 10.1177/2325967121999643. (PMID: 33855098)
• 19 Sallay PI, Friedman RL, Coogan PG. et al. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 1996; 24: 130-136 DOI: 10.1177/036354659602400202. (PMID: 8775108)
• 20 Harris JD, Griesser MJ, Best TM. et al. Treatment of proximal hamstring ruptures – a systematic review. Int J Sports Med 2011; 32: 490-495 DOI: 10.1055/s-0031-1273753. (PMID: 21563032)
• 21 Subbu R, Benjamin-Laing H, Haddad F. Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med 2015; 43: 385-391 DOI: 10.1177/0363546514557938. (PMID: 25404617)
• 22 Best R, Meister A, Huth J. et al. Surgical repair techniques, functional outcome, and return to sports after apophyseal avulsion fractures of the ischial tuberosity in adolescents. Int Orthop 2021; 45: 1853-1861 DOI: 10.1007/s00264-021-04959-w. (PMID: 33963885)
• 23 Atlas sportorthopädisch-sporttraumatologische Operationen. Imhoff AB, Feucht MJ. BerlinHeidelberg: Springer; 2017. DOI: 10.1007/978-3-662-54835-6
• 24 van der Made AD, Wieldraaijer T, Kerkhoffs GM. et al. The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2115-2122 DOI: 10.1007/s00167-013-2744-0. (PMID: 24190369)
• 25 Feucht MJ, Plath JE, Seppel G. et al. Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2576-2582 DOI: 10.1007/s00167-014-3124-0. (PMID: 24929658)
• 26 Otto A, DiCosmo AM, Baldino JB. et al. Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor. Orthop J Sports Med 2020; 8: 2325967119892925 DOI: 10.1177/2325967119892925. (PMID: 31921936)
• 27 Ebert JR, Gormack N, Annear PT. Reconstruction of chronic proximal hamstring avulsion injuries using ipsilateral distal hamstring tendons results in good clinical outcomes and patient satisfaction. Knee Surg Sports Traumatol Arthrosc 2019; 27: 2958-2966 DOI: 10.1007/s00167-018-5310-y. (PMID: 30470850)
• 28 Rust DA, Giveans MR, Stone RM. et al. Functional Outcomes and Return to Sports After Acute Repair, Chronic Repair, and Allograft Reconstruction for Proximal Hamstring Ruptures. Am J Sports Med 2014; 42: 1377-1383 DOI: 10.1177/0363546514528788. (PMID: 24699851)
• 29 Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008; 36: 104-109 DOI: 10.1177/0363546507312167. (PMID: 18055919)
• 30 Marx RG, Fives G, Chu SK. et al. Allograft reconstruction for symptomatic chronic complete proximal hamstring tendon avulsion. Knee Surg Sports Traumatol Arthrosc 2009; 17: 19-23 DOI: 10.1007/s00167-008-0588-9. (PMID: 18682918)
• 31 Lempainen L, Sarimo J, Orava S. Recurrent and chronic complete ruptures of the proximal origin of the hamstring muscles repaired with fascia lata autograft augmentation. Arthroscopy 2007; 23: 441 e441-445 DOI: 10.1016/j.arthro.2006.07.044. (PMID: 17418340)
• 32 Muellner T, Kumar S, Singla A. Proximal hamstring reconstruction using semitendinosus and gracilis autograft: a novel technique. Knee Surg Sports Traumatol Arthrosc 2017; 25: 112-114 DOI: 10.1007/s00167-016-4366-9. (PMID: 27826636)
• 33 Hofmann KJ, Paggi A, Connors D. et al. Complete Avulsion of the Proximal Hamstring Insertion: Functional Outcomes After Nonsurgical Treatment. J Bone Joint Surg Am 2014; 96: 1022-1025 DOI: 10.2106/JBJS.M.01074. (PMID: 24951738)
• 34 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: 2798-2808 DOI: 10.1177/0363546517732526. (PMID: 29016194)
• 35 Sims WF. The Posteromedial Corner of the Knee: Medial-Sided Injury Patterns Revisited. American Journal of Sports Medicine 2004; 32: 337-345 DOI: 10.1177/0363546503261738. (PMID: 14977657)
• 36 Azzopardi C, Beale D, James SL. et al. Isolated Complete Distal Biceps Femoris Tendon Tears: Case Series and Literature Review. Indian J Radiol Imaging 2021; 31: 998-1001 DOI: 10.1055/s-0041-1741106. (PMID: 35136515)
• 37 Branch EA, Anz AW. Distal Insertions of the Biceps Femoris: A Quantitative Analysis. Orthop J Sports Med 2015; 3: 2325967115602255 DOI: 10.1177/2325967115602255. (PMID: 26535398)
• 38 Petersen W, Zantop T. Anatomie der lateralen und medialen Stabilisatoren des Kniegelenks. Arthroskopie 2017; 30: 4-13 DOI: 10.1007/s00142-016-0112-z.
• 39 Bloom DA, Essilfie AA, Lott A. et al. Distal biceps femoris avulsions: Associated injuries and neurological sequelae. Knee 2020; 27: 1874-1880 DOI: 10.1016/j.knee.2020.07.085. (PMID: 33202291)
• 40 Knapik DM, Metcalf KB, Voos JE. Isolated Tearing and Avulsion of the Distal Biceps Femoris Tendon During Sporting Activities: A Systematic Review. Orthop J Sports Med 2018; 6: 2325967118781828 DOI: 10.1177/2325967118781828. (PMID: 30046626)
• 41 Cooper DE, Conway JE. Distal semitendinosus ruptures in elite-level athletes: low success rates of nonoperative treatment. Am J Sports Med 2010; 38: 1174-1178 DOI: 10.1177/0363546509361016. (PMID: 20351198)
• 42 Geronikolakis S, Best R. Isolated rupture of the distal tendon of the biceps femoris muscle in a sport climber: an uncommon injury. Sportverletz Sportschaden 2012; 26: 114-116 DOI: 10.1055/s-0031-1299390. (PMID: 22415714)
• 43 Rehm O, Linke R, Schweigkofler U. et al. Isolated ruptures of the tendon of the biceps femoris muscle. Unfallchirurg 2009; 112: 332-336 DOI: 10.1007/s00113-008-1527-4. (PMID: 19224187)
• 44 Kusma M, Seil R, Kohn D. Isolated avulsion of the biceps femoris insertion-injury patterns and treatment options: a case report and literature review. Arch Orthop Trauma Surg 2007; 127: 777-780 DOI: 10.1007/s00402-006-0216-4. (PMID: 16972058)
• 45 Alioto RJ, Browne JE, Barnthouse CD. et al. Complete rupture of the distal semimembranosus complex in a professional athlete. Clin Orthop Relat Res 1997; 336: 162-165 DOI: 10.1097/00003086-199703000-00023. (PMID: 9060501)