Falotico Guilherme Guadagnini, Scatigna Bruno Francesco
Hip Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Rev Bras Ortop (Sao Paulo). 2025 Sep 8;60(3):s00451810038. doi: 10.1055/s-0045-1810038. eCollection 2025 Jun.
Injuries to the proximal hamstring muscle complex are common in athletes and range from strains to tendinous and bony avulsions. The lesion mechanism typically involves an eccentric contraction of the hamstring muscles during abrupt hip hyperflexion with the knee in extension. Low-speed injuries occur in high kicks and splits, whereas tendon avulsions are common in high-speed activities, such as running and ballet. Clinically, patients present with pain, subcutaneous hematoma, and, sometimes, a palpable defect. Additional signs include limited knee extension and involvement of the sciatic nerve. Diagnosis relies on ultrasonography, magnetic resonance imaging (MRI), and radiography, and MRI is the standard test. Surgical treatment is indicated for complete avulsions, especially in athletes, to prevent loss of strength and difficulty in returning to sports. In the surgical technique herein described, we perform one or two transverse incisions in the gluteal fold, depending on the tendon retraction, followed by fixation with metal anchors. The postoperative period includes initial restriction, followed by accelerated rehabilitation for return to sports by the twelfth week. Since 2019, the technique has been applied to 13 patients, demonstrating good outcomes, without re-ruptures and a postoperative Tegner score similar to the preoperative one.
腘绳肌近端肌肉复合体损伤在运动员中很常见，范围从拉伤到肌腱和骨质撕脱。损伤机制通常涉及在膝关节伸直时突然髋关节过度屈曲过程中腘绳肌的离心收缩。低速损伤发生在高踢腿和劈叉时，而肌腱撕脱在高速活动中很常见，如跑步和芭蕾舞。临床上，患者表现为疼痛、皮下血肿，有时可触及缺损。其他体征包括膝关节伸展受限和坐骨神经受累。诊断依靠超声、磁共振成像（MRI）和X线摄影，MRI是标准检查。对于完全撕脱，尤其是运动员，需进行手术治疗，以防止力量丧失和恢复运动困难。在本文所述的手术技术中，我们根据肌腱回缩情况在臀褶处做一或两个横向切口，然后用金属锚钉固定。术后初期需限制活动，随后在第十二周前加速康复以恢复运动。自2019年以来，该技术已应用于13例患者，显示出良好的效果，无再次断裂，术后Tegner评分与术前相似。
