Janne Sarimo

Complete Proximal Hamstring Avulsions A Series of 41 Patients With Operative Treatment

Background Complete proximal hamstring avulsions can cause considerable morbidity and are often associated with significant functional loss. Hypothesis Early surgical treatment leads to better results than does surgery in the chronic phase. Study Design Case series; Level of evidence, 4. Methods Forty-one patients (21 men and 20 women) with a complete proximal hamstring avulsion were included. The cases were retrospectively analyzed, and a 4-category rating system was used to evaluate the overall result of the surgical treatment. Results The mean follow-up was 37 months (range, 12–72 months). Nineteen patients were rated as having an excellent result and 10 patients a good result. In 5 patients, the result was classified as moderate and in 7 patients poor. In the patients with an excellent or good result, the delay from the injury to surgery averaged 2.4 months, whereas in patients with a moderate or poor result, the delay averaged 11.7 months. The difference was statistically significant (P < .001). Conclusion Excellent or good results can often be expected with surgery, and considerable improvement of symptoms may be achieved even in chronic cases. According to the results, early operative treatment in complete proximal avulsions of the hamstring muscles gives better results than does late surgery and is therefore recommended.

Surgical treatment of partial tears of the proximal origin of the hamstring muscles

Background: Hamstring injuries are common especially in athletes. Partial and complete tears of the proximal origin may cause pain and functional loss. Objective: To evaluate the results of surgical treatment for partial proximal hamstring tears. Methods: Between 1994 and 2005, 47 athletes (48 cases, 1 bilateral) with partial proximal hamstring tears were operated on. The cases were retrospectively analysed. Before surgery, 42 of the patients had undergone conservative treatment with unsatisfactory results, whereas in five patients the operation was performed within four weeks of the injury. Results: The mean length of the follow up was 36 months (range 6–72). The result of the operation was rated excellent in 33 cases, good in nine, fair in four, and poor in two. Forty one patients were able to return to their former level of sport after an average of five months (range 1–12). Conclusion: In most cases, excellent or good results can be expected after surgical repair of partial proximal hamstring tears even after conservative treatment has failed.

Proximal Hamstring Tendinopathy Results of Surgical Management and Histopathologic Findings

Background Tendon disorders are common problems in sports and are known to be difficult to treat. Only limited information is available concerning treatment of proximal hamstring tendinopathy. To the authors’ knowledge, no histopathologic findings of proximal hamstring tendinosis have been published. Hypothesis Surgery (semimembranosus tenotomy and exploration of the sciatic nerve) is an effective treatment for proximal hamstring tendinopathy. Study Design Case series; Level of evidence, 4. Methods A total of 103 cases of proximal hamstring tendinopathy in athletes (58 men, 32 women; 13 bilateral operations) with surgical treatment were included. The cases were retrospectively analyzed, and a 4-category rating system was used to evaluate the overall result. At the follow-up, the patients were asked about possible symptoms and their return to sports. Biopsy samples from 15 of the operated tendons were taken and analyzed by a pathologist. Results The average follow-up was 49 months (range, 12-156 months). The result was evaluated to be excellent in 62 cases, good in 30, fair in 5, and poor in 6. After surgery, 80 of the 90 patients were able to return to the same level of sporting activity as before the onset of the symptoms. This took a mean of 5 months (range, 2-12 months). Typical morphologic findings of tendinosis were found in all biopsy specimens. Conclusion Given the good functional outcome and low complication rate, the authors present surgical treatment as a valuable option in proximal hamstring tendinopathy if conservative treatment fails.

Tension-Band Wiring for Fractures of the Fifth Metatarsal Located in the Junction of the Proximal Metaphysis and Diaphysis

Background Fractures of the proximal fifth metatarsal, other than those involving the tuberosity, have a tendency to delayed union or even nonunion. Hypothesis Tension-band wire technique is a good alternative in treating fractures of the fifth metatarsal located in the proximal junction of the metaphysis and the diaphysis. Study Design Case series; level of evidence, 4. Methods Between 1996 and 2001, a total of 27 cases of proximal metaphysial/diaphysial fractures of the fifth metatarsal were treated with tension-band wiring. All of the patients had undergone prior unsuccessful nonoperative or operative treatment. The mean delay from the diagnosis of the fracture to the final operative procedure was 19.5 weeks (range, 6-48 weeks). Results The mean length of follow-up was 35 months (range, 12-70 months). All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 12.8 weeks, and the return to full activity took 8 to 20 weeks (mean, 14.7 weeks). There were no delayed unions, nonunions, or refractures during the follow-up. Conclusion The tension-band wire technique seems to give good results in the treatment of proximal metaphysial/diaphysial fractures of the fifth metatarsal in cases of primary unsuccessful nonoperative treatment or primary unsuccessful intramedullary screw fixation.

Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment

Background: Hamstring strains are among the most frequent injuries in sports, especially in events requiring sprinting and running. Distal tears of the hamstring muscles requiring surgical treatment are scarcely reported in the literature. Objective: To evaluate the results of surgical treatment for distal hamstring tears. Design: A case series of 18 operatively treated distal hamstring muscle tears combined with a review of previously published cases in the English literature. Retrospective study; level of evidence 4. Setting: Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland. Patients: Between 1992 and 2005, a total of 18 athletes with a distal hamstring tear were operated at our centre. Main outcome measurements: At follow-up, the patients were asked about possible symptoms (pain, weakness, stiffness) and their return to the pre-injury level of sport. Results: The final results were rated excellent in 13 cases, good in 1 case, fair in 3 cases and poor in 1 case. 14 of the 18 patients were able to return to their former level of sport after an average of 4 months (range 2–6 months). Conclusions: Surgical treatment seems to be beneficial in distal hamstring tears in selected cases.

Clinical principles in the management of hamstring injuries.

PurposeHamstring injuries are among the most common muscle injuries seen in sports clinical practice. This narrative review covers essential knowledge of hamstring injuries, ranging from strains to total proximal three-tendon ruptures. The primary aim is to provide basic information for clinicians and sports medicine therapists dealing with hamstring problems.MethodsIn this review, existing literature of hamstring injuries was taken together. Emphasis was given to subjects less well covered in previous reviews, such as preventive measures, as well as the most relevant information needed in the treatment of these injuries.ResultsOccasionally, symptoms remain after hamstring injuries which can be successfully treated with surgery. Knowledge of the effectiveness of preventive measures and nonsurgical and surgical treatment is limited by small studies of low evidence level.ConclusionsEvidence-based treatment algorithms are not available. Larger studies of better quality with more concrete grading of hamstring tears are needed to improve knowledge in prevention and treatment of hamstring injuries.Level of evidenceIV.

Total proximal tendon avulsion of the rectus femoris muscle

Total proximal avulsions of the quadriceps femoris muscle group are rare injuries. Between the years 2001 and 2004 five patients with a total proximal avulsion of the tendon of the rectus femoris muscle were treated surgically in Mehiläinen Hospital in Turku, Finland. The median age of the patients was 21 years (range, 19–27) and the patients were all men. There were four soccer players and one hurdler.

Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients.

Background and Aims: Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination. Material and Methods: A total of 320 patients were examined arthroscopically between the years 1994 to 96 in the Turku University Hospital. Patients with other than chondral or osteochondral fractures were excluded. Results: The most common arthroscopic findings were rupture of the ACL (45 %), dislocation of the patella (23 %) and meniscal tear (21 %). In only 113 (35 %) cases an immediate therapeutic procedure was performed in addition to the arthroscopic examination. Conclusions: Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation.

Anterior Mid-Tibial Stress Fractures. Results of Surgical Treatment:

Background and Aims: An anterior mid-tibial stress fracture is an uncommon, but possibly career threatening condition for an athlete. We wanted to evaluate the results of the surgical treatment of this notorious stress fracture and compare two different surgical methods. Material and Methods: Forty-nine anterior mid-tibial stress fractures were treated surgically in 45 patients during the years 1985–2005. All the patients were athletes, mainly runners. The mean age of the patients was 26 years. Thirty-four of the fractures occurred in men and 15 in women. The first method of treatment (anteromedial and lateral drilling) was used in 20 operations and the second method (laminofixation) in 29 operations. Results: Good results were achieved with drilling in only 50% of the operations, where as with laminofixation good results were achieved in 93% of operations. This difference was statistically significant (p = .002). Healing of the stress fracture after laminofixation occurred in less than 6 months. The length of the plate used in the laminofixation had no effect on the end result. Conclusions: An anterior mid-tibial stress fracture may often lead to delayed union or non-union in vigorously training athletes. Surgical treatment with laminofixation proved to be superior to tibial fracture site drilling.

Comparison of Two Procedures for Meniscal Cysts: A Report of 35 Patients with a Mean Follow-up of 33 Months:

Background: The cause, pathogenesis, and appropriate treatment of meniscal cysts remain controversial. Purpose: We wanted to evaluate the results of treatment of meniscal cysts with two different operative procedures. Study Design: Prospective cohort study. Methods: Two different operative procedures were compared. Sixteen patients (group 1) had an open excision of the cyst performed in addition to arthroscopic examination of the knee. Nineteen patients (group 2) were treated entirely arthroscopically. The postoperative treatment course was the same for both groups. The mean length of follow-up was 33 months. Results: The results were excellent or good in 86% of the patients (30 of 35) and were equally good for both procedures. Patients with degenerative changes of the knee joint seemed to have a less favorable outcome. Conclusions: Good or excellent results can be expected from either open or arthroscopic treatment of meniscal cysts.