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Review
. 2021 Dec;110(4):483-491.
doi: 10.1177/1457496920984274. Epub 2021 Feb 21.

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal-a new individual muscle-tendon concept in athletes

Lasse Lempainen  1   2 , Jussi Kosola  2   3 , Ricard Pruna  4 , Juha-Jaakko Sinikumpu  5 , Xavier Valle  4 , Olli Heinonen  2 , Sakari Orava  6   2 , Nicola Maffulli  7   8
Affiliations
Review

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal-a new individual muscle-tendon concept in athletes

Lasse Lempainen et al. Scand J Surg. 2021 Dec.

Abstract

Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing.

Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced.

Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience.

Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.

Keywords: Hamstring injury; athlete; biceps femoris; semimembranosus; semitendinosus; surgical treatment; tendon.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1.
Fig. 1.
The illustrative drawing of each individual hamstring structure: A) tendons, B) muscles.
Fig. 2.
Fig. 2.
Comparison between current and modern treatment algorithms based on the present literature.
Fig. 3.
Fig. 3.
Complete three-tendon proximal hamstring rupture with a clear retraction at the right side.
Fig. 4.
Fig. 4.
Perioperative image of the complete proximal two-tendon (BF and ST)—rupture. Arrow showing the ruptured area.
Fig. 5.
Fig. 5.
Isolated complete proximal single-tendon rupture: A) BF (MRI and perioperative images), B) SM (MRI and perioperative images).
Fig. 6.
Fig. 6.
A) Distal tendon rupture of the ST (MRI and perioperative images before and after repair) and B) distal MTJ area rupture of the BF (MRI images, arrows indicate the retracted muscle belly and tendon stump).
Fig. 7.
Fig. 7.
A) Central tendon rupture of the SM (recurrent injury, MRI and perioperative images before and after repair) and B) BF (acute injury, MRI).
See this image and copyright information in PMC

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