Department of Orthopaedic Surgery, Duke University Medical Center, 311 Trent Drive, Durham, NC 27710, USA.
Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128, USA.
Clin Sports Med. 2021 Apr;40(2):339-361. doi: 10.1016/j.csm.2021.01.003. Epub 2021 Feb 10.
Proximal hamstring injuries can present as chronic tendinosis, acute strain, partial tendinous avulsions, or complete 3-tendon rupture. Nonoperative management for chronic insertional tendinosis and low-grade tears includes activity modification, anti-inflammatories, and physical therapy. Platelet-rich plasma injections, corticosteroid injections, dry needling, and shock wave therapy are newer therapies that also may provide benefit. Surgical indications include complete, proximal avulsions; partial avulsions with least 2 tendons injured with more than 2 cm of retraction in young, active patients; and partial avulsion injuries or chronic tendinosis that have failed nonoperative management. Surgical management entails open primary repair, endoscopic primary repair, or augmentation/reconstruction.
近端腘绳肌损伤可表现为慢性腱病、急性拉伤、部分肌腱撕脱或完全 3 肌腱断裂。慢性插入性腱病和低级别撕裂的非手术治疗包括活动调整、抗炎药和物理治疗。富血小板血浆注射、皮质类固醇注射、干针和冲击波治疗是新的治疗方法，也可能有疗效。手术指征包括完全、近端撕脱；在年轻、活跃的患者中，至少有 2 根肌腱损伤，且有 2 厘米以上回缩的部分撕脱；以及经非手术治疗失败的部分撕脱损伤或慢性腱病。手术治疗包括开放性初次修复、内镜初次修复或增强/重建。
