Department of Trauma and Orthopaedic Surgery, University College Hospital, Fitzrovia, London, UK.
Department of Orthopaedic Surgery, The Princess Grace Hospital, Marylebone, London, UK.
Am J Sports Med. 2020 Aug;48(10):2456-2464. doi: 10.1177/0363546520938679.
Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported.
Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence.
Case series; Level of evidence, 4.
This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery.
All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery.
Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.
非手术治疗腘绳肌远端肌-腱联合 T 型损伤需要经历不同阶段的康复期，且复发风险较高。据我们所知，目前尚未有研究报道手术治疗此类急性损伤的疗效。
手术修复腘绳肌远端肌-腱联合 T 型损伤可使患者恢复至伤前运动水平，且复发风险低。
病例系列研究；证据等级，4 级。
本前瞻性单外科医生研究纳入了 34 名职业运动员（平均年龄 26.4 ± 3.1 岁；31 名男性[91.2%]；3 名女性[8.8%]；体重指数 25 ± 2.0 kg/m²），他们均接受了急性腘绳肌远端肌-腱联合 T 型损伤的初次手术修复。所有研究患者均接受了标准化的术后康复方案。术后定期记录与重返运动活动时间、患者满意度、关节活动度、腘绳肌肌力、被动关节活动度、功能进展和并发症相关的既定研究结果。自手术日期起，平均随访时间为 28.4 个月（范围，24.0-36.3 个月）。
所有研究患者均恢复至伤前运动水平。从手术修复到完全恢复运动的平均时间为 11.7 ± 3.6 周。无患者出现原发性损伤复发。在 1 年随访时，18 名患者（52.9%）非常满意，16 名患者（47.1%）对手术结果满意。术后 3 个月，患者的被动直腿抬高平均角度（69.7°±11.7° vs 24.1°±7.4°；<.001）增加，等长腘绳肌肌力在 0°（93.1%±5.4% vs 63.1%±7.7%；<.001）、45°（76.8%±9.7% vs 24.8%±8.3%；<.001）和 90°（96.4%±3.9% vs 85.6%±5.9%；<.001）时均有所提高，下肢功能评分平均（64.5±4.5 vs 27.2±5.4；<.001）增加，Marx 活动评分平均（10.7±2.7 vs 2.2±2.1；<.001）改善。术后 1 年和 2 年时，患者的满意度和功能评分仍保持较高水平。
手术修复腘绳肌远端肌-腱联合 T 型损伤可使患者获得较高的满意度、增强肌肉力量、提高功能评分，并使患者在短期内（<2 年）恢复至伤前运动水平，且复发风险低。
