Indications for Surgical Treatment in Hamstring Tears

Fig. 26.1

(a, b) Isolated tear of the semimembranosus tendon at right. (a) On an axial MR image, the tendon is absent (arrow) at the level of the ischial tuberosity (asterisk). (b) A coronal image shows the retracted tendon (arrow) distal to the tuberosity (asterisk)

Fig. 26.2

(a, b) MR images showing a complete tear of the hamstring tendons at left. (a) On an axial image, the tendons are absent (arrow) at the level of the ischial tuberosity (asterisk). (b) As seen on an oblique sagittal image, the tendons are retracted and coiled a few centimeters distal to the tuberosity (asterisk)

Fig. 26.3

(a, b) MR images showing a complete tear of the hamstring tendons at left. (a) On an axial image, only the conjoint tendon of biceps and semitendinosus is absent (arrow) at the level of the ischial tuberosity (asterisk). (b) A coronal image reveals that, although the semimembranosus tendon is not retracted (arrow), it is detached from the tuberosity (asterisk)

Distal tears of the hamstrings are rare (Lempainen 2007a). The BF is most commonly affected and most of the tears are incomplete. The BF or the semitendinosus (ST) may, however, rupture completely from the distal bony insertion or at the distal myotendinous junction (Fig. 26.4a, b). To our knowledge there are no reports of complete SM avulsions. An acute complete rupture (BF or ST) with a retraction should be repaired anatomically. In our opinion the behavior of an acute distal ST avulsion is not similar to that of harvesting the tendon for graft purposes (Lempainen 2007a).

Fig. 26.4

(a, b) Distal tear of the long head of the biceps femoris tendon at right. (a) An axial MR image shows the torn tendon (arrow) surrounded by fluid. Intact biceps femoris muscle and tendon can be seen at left (asterisk). (b) A coronal image shows the retracted muscle (arrow). Normal muscle is seen at the contralateral side (asterisk)

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