Currently, there are no texts focused on proximal hamstring pathology and surgical treatment options. While midsubstance muscle tears of the hamstring are typically treated non-operatively, proximal hamstring tears often require surgery, which can create anxiety for the orthopedic surgeon, as the exposure is deep and the sciatic nerve is at risk for injury. Moreover, the algorithm for repairing proximal hamstring tears is complex, as the spectrum of pathology starts from partial tears to acute tears to chronic tears with varying degrees of retraction. With the advent of arthroscopic procedures around the hip, innovative treatment methods such as endoscopic surgery have been utilized to repair the proximal hamstring. For successful treatment of chronic hamstring tendon tears, allograft reconstruction has been shown to be successful. The book opens with a thorough review of the relevant functional anatomy of the hamstring and related structures, before moving on to discuss epidemiology, classification and biomechanics of injury. The main focus, however, is on treatment strategies, from non-operative methods, including cutting-edge biologics, to open, endoscopic and arthroscopic approaches for partial, acute and chronic tears. The management of complications and rehabilitation protocols round out the presentation. Detailed illustrative case examples provide real-world demonstration of each chapter's concepts. Practical and user-friendly, Proximal Hamstring Tears will be very useful for the sports medicine, orthopedic surgery, rehabilitation medicine, and physical therapy communities.
Author(s): Thomas Youm
Publisher: Springer
Year: 2020
Language: English
Pages: 157
City: Cham
Preface
Contents
Contributors
1: Functional Anatomy of the Hamstrings
Introduction
Semitendinosus
Origin
Insertion
Innervation
Anatomical Variants
Biceps Femoris Muscle Long Head
Origin
Insertion
Innervation
Anatomical Variants
Biceps Femoris Short Head
Origin
Insertion
Innervation
Anatomical Variants
Semimembranosus
Origin
Insertion
Innervation
Anatomical Variants
Collective Function of the Hamstrings
Individual Function of the Hamstrings
References
2: Epidemiology, Biomechanics, and Classification of Proximal Hamstring Injuries
Epidemiology
Biomechanics
Classification
References
3: Nonoperative Treatment of Proximal Hamstring Tendon Tears
Introduction
Anatomy
Mechanism of Proximal Hamstring Injury
Risk Factors for Proximal Hamstring Injuries
Clinical Presentation
Indications and Contraindications for Nonoperative Management
Nonoperative Management Techniques
Physical Therapy
Conventional Therapy
Eccentric Rehabilitation
Trunk Stabilization
Rehabilitation Protocol
Non-steroidal Anti-inflammatories
Corticosteroid Injections
Platelet-Rich Plasma
Shockwave Therapy
Return to Play After Nonoperative Treatment
Outcomes Following Nonoperative Management
Conclusion
References
4: Surgical Treatment of Partial Proximal Hamstring Tendon Tears
Introduction
History and Physical Exam
Imaging
Treatment
Open Repair
Endoscopic Repair
Authors’ Preferred Technique: Endoscopic Repair
Case
References
5: Surgical Treatment of Acute Proximal Hamstring Tendon Tears
Indications for Acute Repair
Operating Room Setup
Endoscopic Repair
Open Repair
Tendon Fixation
Postoperative Care
Outcomes
Complications
Conclusion
Case Report #1
Case Report #2
References
6: Surgical Management of Chronic Proximal Hamstring Tendon Tears
Introduction
Indications and Contraindications
Indications
Contraindications
Surgical Technique
Positioning
Approach
Superficial Dissection
Sciatic Neurolysis
Deep Dissection
Graft Selection
Graft Augmentation
Bridging Repair
Bone Plug
Suture Anchors
Postoperative Rehabilitation
Outcomes
Conclusion
Case Report #1
Case Report #2
References
7: Endoscopic Treatment of Proximal Hamstring Tendon Tears
Introduction
Surgical Technique
Postoperative Management
Summary
Case Study
References
8: Open Versus Endoscopic Approaches to Proximal Hamstring Tendon Tears: Techniques, Pearls, and Pitfalls
Introduction
When to Do Open Surgery Versus Endoscopic Surgery
Learning Curve
How to Decide Between Open and Endoscopic Approaches?
Partial Tears and Techniques
Full Thickness Tears and Techniques
Patient Characteristics That May Help Guide Selection of Endoscopic Versus Open Technique
Age
Body Habitus
Tear Retraction and Chronicity
Location of Tear
Outcomes
Cases
Case 1
Management
Case 2
Management
Conclusion
References
9: Surgical Complications of Proximal Hamstring Tendon Tears
Introduction
Nonspecific Surgical Complications
Wound-Related Complications
Deep Venous Thrombosis and Pulmonary Embolus
Specific Proximal Hamstring Complications
Neurological Injury
Muscular Complications
Pain and Stiffness
Complications Related to Endoscopic Management
Conclusion
References
10: Biological Treatment of Proximal Hamstring Tendon Tears
Introduction
Basic Science of Tendon Healing
Platelet-Rich Plasma
Other Injected Biologics
Authors’ Preferred Treatment
Equipment
Positioning and Technique
Risks and Complications
Conclusion
References
11: Rehabilitation After Surgery for Proximal Hamstring Tendon Tears
Principles of Rehabilitation
Suggested Postoperative Protocol
Outcomes Following Rehabilitation
Conclusion
References
12: Proximal Hamstring Injury Rehabilitation and Injury Prevention
Introduction
Risk Factors
Prevention
Nonoperative Rehabilitation
References
Index
