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We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon overuse injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular fragment is best seen in weightbearing lateral view radiographs and isotope scan and/or tomography help confirm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time. [ABSTRACT FROM AUTHOR]

A series of 59 patients was treated and operated on for pain felt over the area of the ischial tuberosity and radiating down the back of the thigh. This condition was labeled as the "hamstring syndrome." Pain was typically incurred by assuming a sitting position, stretch ing the affected posterior thigh, and running fast. The patients usually had a history of recurrent hamstring "tears." Their symptoms were caused by the tight, tendinous structures of the lateral insertion area of the hamstring muscles to the ischial tuberosity. Upon divi sion of these structures, complete relief was obtained in 52 of the 59 patients. [ABSTRACT FROM PUBLISHER]

From 1971 to 1985, 369 athletes presented to us with stress fractures. Of these patients, 10% (37) were treated for development of delayed unions or non unions. Twenty-seven of the patients were male and 10 were female. Their mean age was 23.1 years (range, 17 to 39). About half of the athletes were involved in endurance sports. The diagnostic criteria for a delayed union or nonunion were clinical and radiological evi dence. There was a diagnostic delay of about 3.5 months in the series. Plain radiographs, tomography, and isotope scans were used in the diagnosis. Special radiographic views were also used. In 15 cases (10 hallux sesamoid bone fractures, 1 midtibial shaft frac ture, 1 metatarsal V base fracture, 1 tarsal navicular fracture, 1 olecranon fracture, and 1 proximal tibial shaft fracture) nonoperative treatment was used. Operative treatment was used 22 times (5 sesamoid fractures, 5 midtibial fractures, 5 metatarsal V base fractures, 3 tarsal navicular fractures, 3 olecranon fractures, and 1 proximal tibial shaft fracture). Results were good or excellent in 32 cases (86.5%), moderate in 4 cases, and poor in 1 case. [ABSTRACT FROM PUBLISHER]

Three cases of the antebrachial-palmar hammer syndrome are described in volley ball players. They all suffered from a decreased blood perfusion of their right hand and fingers due to the repeated ball and floor impacts during the volley ball training and playing. The vascular lesions of the radial and ulnar arteries were reversible. The patients recovered spontaneously during the rest from excessive physical activity by their hands. The vascular lesions of this kind are rare but seem to be typical to volley ball players. [ABSTRACT FROM AUTHOR]

Osteochondroses are disorders of primary and secondary growth centres, or lesions at the apophyseal or epiphyseal growth areas of bones. Although there are many types of osteochondroses, the history, clinical symptoms and findings as well as radiological findings are typical. Physical exercise is one of the factors that provokes symptoms. In a series of 185 osteochondroses in active young athletes, there were 18 different disorders. The commonest were Osgood-Schlatter's disease, Sever's disease, osteochondritis dissecans of the femoral condyles, various other patellar osteochondroses and Scheuermann's disease. Most of the athletes were from individual events; track and field sports (53.5%), cross-country skiing (8.1%), gymnastics (3.2%) and power events (2.7%). Of the team sports soccer produced the most (20.0%). The treatment was conservative in 84.3% and operative in 15.7%. The duration of symptoms in these athletes persisted in about 43% for less than one year and in 57% for more. The late changes of osteodhondroses do not cause serious risks for a normal life, if the treatment is active and the follow-up efficient. [ABSTRACT FROM AUTHOR]

Because sports injuries in men form most of the available statistics, the reportage of injuries in female athletes is sparse. We describe exertion injuries and disorders in 281 women athletes, all of which hampered athletic training or performances. Sixty per cent of the injuries occurred to girls ages between 12-19 years, and about forty-eight per cent were track and field athletes. The most common sites of injury were the ankle, foot, heel and leg. Osteochondritic disorders were the most typical injuries in the series, and the chronic medical tibial syndrome was the injury that needed surgical treatment most frequently. Overuse injuries seem to differ very little from each other in the events included in this survey. [ABSTRACT FROM PUBLISHER]

The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. [ABSTRACT FROM PUBLISHER]

An uncommon exertion pain on the lateral side of the knee is described in 88 patients, in four of whom it was bilateral. The disorder is a result of the friction of the iliotibial tract over the lateral femoral epicondyle. The syndrome is the iliotibial tract friction syndrome of ITFS. All the patients in the material were active athletes or middle-aged joggers in regular training. The cases were seen over four years and four months. The mean age of them was approximately 25 years, and there were only nine women in the series. Th pain appeared usually after running and was localised on the outer femoral condyle, and often radiated downwards along the iliotibial tract. Conservative treatment and changes in training habits cured most cases. The disorder has not often been described in the literature, and seems to appear only in physically very active people, such as athletes or military recruits. [ABSTRACT FROM PUBLISHER]

A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases. [ABSTRACT FROM PUBLISHER]

34 cases of avulsion fractures are described. Each fracture took place during athletic training or competition. Excepting six sportsmen participating in a general fitness programme, every patient was an active competitive athlete. There were six women and 28 men; their average age was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most avulsion fractures took place in sprinters and hurdlers; next were middle and long distance renner, footballers, fitness joggers, skiers and ice-hockey players. The most usual location of a fracture was the anterior pelvic spines; avulsion fractures were also detected in various parts of lower limbs. There were fewer avulsion fractures in the area of the trunk and upper extremities. Roetgenologically, the diagnosis of an avulsion fracture is generally easy to make. However, the diagnosis is facilitated by knowing the mechanism of the injury, the technique of the athletic event, and some of the training methods. Generally, a fracture heals well, even if it requires both sufficient immobilisation and some delay in resuming physical exertion. [ABSTRACT FROM PUBLISHER]

A series of surgically treated patellar tendon lesions among athletes is presented. The material was collected during 5 years from three sports injury clinics and from two hospitals. During this period the authors treated about 150 cases of jumper's knee, of which 34 cases were treated by operation. The athletes were mostly volley ball players, jumpers or runners. The operation revealed a necrotic focus of the patellar tendon in 21 cases, the retinaculum was thick and adherent in 16 patients and an exostosis of the patellar insertion was seen in two cases. The necrotic areas were excised, the thick and adherent retinaculum was divided and the exostoses were excised and drilled. Surgical treatment of chronic patellar tendon pains may give good results in selected cases. [ABSTRACT FROM PUBLISHER]

Introduction: an acromioclavicular joint (AC-joint) separation typically occurs after falling on the shoulder. Treatment is often conservative. In type III-V dislocations the pronounced lifted position and anterior- posterior translation of the distal clavicle may cause problems among physically active patients and operative treatment may be considered. Material and methods: we present our arthroscopic anatomical double bundle coracoclavicular (CC) reconstruction technique using a 4 mm semitendinosus tendon autograft The unique aspect of our technique is the position of the dorsal limb of the graft around the dorsal edge of the clavicle reconstructing the conoid ligament. The anterior limb projects superiorly and replaces the trapezoid ligament. A significant advantage is that there is only one 6-mm drill hole in the clavicle and a 4.5-mm drill hole in the coracoid. An additional advantage is that the temporary fixation apparatus uses the same drill holes. These drill holes are the smallest possible if a distal button fixation and semitendinosus graft are used. The solution effectively stabilizes the AC- joint and prevents anterior posterior translation. There are two alternatives for temporary fixation. A combination of a GraftWasher, a TightRope distal button and #5 Fiber- Wire in acute cases and lighter built patients. The second is a GraftWasher, a Dog Bone button and FiberTape (Arthrex Inc, Naples, FL) in chronic cases or more heavily built patients. Postoperatively, the patients use a gunslinger brace for 4 weeks. The patients are allowed to flex and extend the elbow. Light waistline movements are also allowed within the limits of pain. Rehabilitation is started 4-6 weeks after surgery with gentle passive exercises. At 8 weeks, free range of motion is allowed. Returning to contact sports, such as ice hockey, is permitted after 6 months. 23 patients have been operated so far. The longest follow up time is now 1 ½ years. Results: in this series the first results of the operation were evaluated 6 months after the operation. The outcomes of the operation were divided into 4 categories: excellent, good, fair, and poor. The outcome was considered excellent if the patient was able to return to work or sports with no difficulty, had normal range of motion of the arm with no restrictions, and subjectively considered the outcome excellent. The result was regarded as good if the range of motion was full but there was still some stiffness, if the patient had occasional pain using the arm, or if a small bump (under 10 mm) remained in the AC joint. The outcome was considered fair if there was a bump (over 10 mm) remaining in the AC joint and the patient had frequent pain in the AC joint. If the stabilization of the clavicle failed, the outcome was considered poor. Preliminary patient outcomes were identified at 6 months postoperatively. In twelve patients, the outcome was excellent. In four patients, the outcome was determined to be good since there were slight pain in the AC- joint or a remaining bump under 10 mm. Seven patients are still in the early phase of recovery. The follow ups will continue. Conclusion: the results have been very promising and the patients have been able to return to high demand sports or heavy labor. An all-arthroscopic double-bundle coracoclavicular joint reconstruction is an effective and reliable method in stabilizing the clavicle and neutralizing the anteriorposterior translation, and we find it to be technically practical for the surgeon. [ABSTRACT FROM AUTHOR]

Background: Making a diagnosis of proximal hamstring tendinopathy (PHT) may be challenging, as patients with correlating clinical symptoms may have normal or minimal findings on magnetic resonance imaging (MRI) scans., Purpose/hypothesis: The purpose of this study was to assess the effect of a novel hip flexion (HF) scanning position on the MRI diagnosis of PHT. It was hypothesized that the HF position, which simulates the symptom-provoking sitting position, would reveal PHT pathology more accurately than the standard scanning position., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: Patients with chronic PHT symptoms were included. Chronicity was defined as symptoms that were present for >3 months. Each patient underwent an MRI in 2 parts: (1) the standard pelvic examination in the supine position and (2) the novel HF position in which the patient lays on his or her side with the hip at 90° of flexion. Tendon insertion areas of the semimembranosus and the biceps femoris were analyzed independently by 2 experienced musculoskeletal radiologists, and the findings were classified as normal , tendinosis , or rupture . The MRI findings for both the standard and HF positions were compared in every patient, and the percentage of different diagnoses between the 2 MRI positions was reported., Results: In total, 38 patients (67 tendons) were analyzed. In 71% of the patients, the HF position revealed more severe injury than the standard position. The HF position showed a rupture in 16% of the tendons, with findings classified as tendinosis in the standard position. Of the tendons diagnosed as normal in the standard position, 6% were classified as rupture and 11% as tendinosis in the HF position., Conclusion: The novel HF scanning position offered additional value in the diagnosis of PHT in symptomatic patients when compared with the standard hip-in-neutral position. This position can improve the diagnostics of PHT, especially if an athlete or an active patient with gluteal area pain has normal or minimal MRI findings in the standard position., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Hospital District of Southwest Finland (ref No. 37/1801/2019)., (© The Author(s) 2024.)

Background: Data regarding the diagnosis of Proximal Hamstring Tendinopathy (PHT) is limited. There is a need for a standardized, valid, and reliable instrument for evaluating PHT among Spanish population. The purpose of this study was to linguistically validate and cross-culturally adapt the Spanish version of the VISA-H for Spanish population and to assess its readability, initial feasibility, appropriateness and acceptability., Methods: Cross-cultural adaptation was done according to established guidelines. Process included 5 steps: independent translations, synthesis of the translations, back-translations, expert committee, and pre-test. The linguistic validation of the questionnaire followed a standard methodology that included comprehension test interviews to assess the relevance, understanding and acceptability of the VISA-H. Comprehension was analyzed with cognitive interviews of 18 Spanish Professional basketball and soccer players (n = 8 male, n = 10 female end-users, healthy individuals at risk), using think-aloud and probing techniques., Results: All subjects (18/18) reported that the items were clear and did not cause upset. Additionally, every respondent had no difficulty in completing the form and found it fairly easy. No difficulties with the instructions were reported. Readability score resulted in adequate levels of understanding (Fernandez-Huerta score of 67.5), showing high level of acceptability., Conclusion: The results of the linguistic and semantic validation conducted with health risky population enable the identification that the Sp-VISA-H was well accepted and easily understood by the participants. Further testing on PHT patients is needed to corroborate these preliminary data., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper., (2022 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Objective: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB)., Design: Case series, level of evidence IV., Setting: University teaching hospital., Patients: This study reports 8 patients who developed postoperative CBB after having started impact training too early., Intervention: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI., Main Outcome Measures: Detection of CBB after EPCC., Results: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5-11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6-16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2-9 months) after the diagnosis of postoperative CBB., Conclusions: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing., Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced., Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience., Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.

Background: The optimal treatment for complete avulsions of the proximal adductor longus (AL) is still debatable, and different operative and nonoperative treatment options have been suggested., Purpose: To report surgical techniques and functional outcomes of a series of athletes who were treated operatively for proximal AL tears., Study Design: Case series; Level of evidence, 4., Methods: A retrospective evaluation of patients who underwent surgical repair of complete proximal AL tear with concomitant distal fascial release with or without lesions of the neighboring soft tissue structures was performed. This included preinjury Tegner score, age, number of tendons involved, time interval from injury to surgery, and postoperative complications. Self-reported outcomes were defined based on the ability to regain sports activities (excellent, good, moderate, fair, or poor). Between-group comparisons were performed to identify factors associated with improved outcomes. The Mann-Whitney nonparametric test was used for comparing continuous variables, and the Fisher exact test was used for comparing nominal variables., Results: A total of 40 male athletes were included in the evaluation, with an average follow-up of 11 months (range, 6 months-8 years). Self-reported outcome was excellent in 23 (57.5%), good in 13 (32.5%), and moderate in 4 (10%) patients. Comparisons between patients with excellent versus good/moderate outcomes revealed nonsignificant differences regarding age at injury and preinjury Tegner score. Athletes with excellent outcomes received surgery sooner after the injury compared with athletes with good/moderate outcomes (2.4 ± 1.8 vs 11.4 ± 11.0 weeks, respectively; P < .01)., Conclusion: Surgical repair for complete proximal AL tears with a concomitant distal fascial release resulted in outcomes rated as good or excellent in 90% of the cases. This treatment should be considered particularly in high-level athletes with a clear tendon retraction and within the first month after the injury. Further research is nevertheless needed to compare these outcomes with other treatment alternatives to better define criteria advocating surgery., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Severe rectus femoris central tendon rupture is an uncommon sports-related injury. Most rectus femoris central tendon injuries can be treated by nonoperative means, but some tend to reinjure, resulting in chronic symptoms. Physicians treating athletes with rectus femoris injuries should be aware of this clinical condition and know that surgical treatment could be beneficial to the athlete if the rectus femoris central tendon rupture becomes chronic., Purpose: To describe the clinical picture, magnetic resonance imaging (MRI) findings, and surgical treatment results of rectus femoris central tendon injuries., Study Design: Case series; Level of evidence, 4., Methods: This study included 12 patients who underwent successful repair of recurrent rectus femoris central tendon rupture. Presurgical MRI scans were obtained and compared with the surgical findings. The time of return to play was recorded, and the outcome of surgical treatment was evaluated with validated Subjective Patient Outcome for Return to Sports (SPORTS) criteria: good = full return to preinjury level of sports without any symptoms; moderate = return to preinjury level of sports with some residual symptoms (mild discomfort during sports); and poor = did not return to preinjury level of sports., Results: Overall, 10 patients had a good outcome (83%), and 2 had a moderate outcome (17%). All athletes included in the study were able to return to sport at their preinjury levels 2.5 to 4 months postoperatively. Presurgical MRI scans correlated well with the surgical findings., Conclusion: The surgical treatment of rectus femoris central tendon rupture seems to be a good option in chronic and recurrent cases. After surgery and successful rehabilitation, the athlete is expected to continue sports at the preinjury level., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Proximal rectus femoris (PRF) tears are relatively rare injuries among top-level athletes. PRF injuries can be avulsions of both tendon heads (direct and reflected heads) or of a single head, and some have a tendency to progress to recurrent injuries., Purpose: To describe a series of operatively treated PRF ruptures in professional soccer players., Study Design: Case series; Level of evidence, 4., Methods: Nineteen cases of PRF injuries (18 patients, 1 bilateral) in professional soccer players who were treated surgically were retrospectively reviewed. Perioperative findings with return-to-play data were recorded., Results: Of the PRF injuries, 10 total avulsions (both heads) and 9 single-head tears were seen on magnetic resonance imaging and were later confirmed during surgery. All 18 patients returned to their preinjury level of play (mean follow-up, 2.8 years [range, 1-11 years])., Conclusion: The repair of PRF tears in professional soccer players yielded good results and allowed all patients to return to their preinjury level of play., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Introduction: Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes., Materials and Methods: Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up., Results: Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes., Conclusions: Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery., Level of Evidence: Case series, IV.

Background: As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings., Purpose: To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes., Study Design: Case series; Level of evidence, 4., Methods: Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored., Results: Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up., Conclusion: Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Background: Semitendinosus (ST) is widely used autograft in anterior cruciate ligament reconstructions (ACLR). Although tendon harvesting is a common procedure, some patients exhibit pain, cramping and dysfunctional at posterior thigh after the ACLR. The formation of the newly regenerated neotendon could be compromised by a new injury or too rapid rehabilitation. We present this clinical entity and the developed surgical technique and share our experience in treatment of these patients., Methods: Ten patients underwent operation where the harvested, retracted and loose muscle (9 ST, 1 gracilis) was reattached again. The delay to the diagnosis and the outcome of the procedure were recorded. Cases were followed and magnetic resonance images (MRI) were included from 2 cases for the demonstration of postoperative healing., Results: Six ST and the gracilis patients with prolonged symptoms had good results and returned to their normal activity level. Preoperative MRI showed increased signal intensity and edema of the harvested and retracted muscles as the sign of compromised healing of the neotendon. Postoperatively, these MRI findings were resolved., Conclusions: In high activity level patients with chronic posterior thigh pain and cramping of the harvested muscle, the stabilization procedure of the poorly healed muscle belly could lead to beneficial outcome., Level of Evidence: IV. Case series., Competing Interests: Conflicts of interest The Authors declare no conflicts of interest for this study.

Purpose: The purpose of this study was to report characteristics and outcomes of surgical excision of symptomatic mature posttraumatic myositis ossificans in adult athletes. The hypothesis was that surgical excision of the ossified mass in these circumstances can effectively relief symptoms and result in return to high-level sports with minimal postoperative complications., Methods: All operations involving excision of posttraumatic heterotopic ossifications performed between 1987 and 2015 were reviewed. Included cases had isolated excision of posttraumatic myositis ossificans, whereas excluded cases had: (1) concomitant reattachment of tendon to bone; (2) chronic overuse injuries which preceded the development of the heterotopic mass or large calcifications which were excised from tendon-to-bone insertions; and (3) excision of heterotopic ossification from a ligament, capsule, or tendon insertion following avulsion injury without tendon-to-bone repair. After surgery, return to sports was allowed at 4-6 weeks., Results: Of 57 athletes undergoing excision of heterotopic ossifications, 32 were eligible as isolated excision of posttraumatic myositis ossificans. Twenty-four (75%) were ice hockey or soccer players. Median age was 23 years. Prior to surgery, patients were unable to continue their sports. At surgery, the ossification was excised from a thigh muscle in 27 (84%) cases. Median follow-up was 2 years (range 1-20 years). Outcome was Good/Excellent in 26 (81%) patients, corresponding to return to preinjury sports with minimal symptoms at sports activities. Preinjury Tegner activity level was resumed after surgery in 30 of 32 (94%) athletes, of whom 28 (94%) were involved in high-level sports corresponding to Tegner levels 8-10. No postoperative complications were recorded other than minimal insensitive areas at the periphery of skin incisions., Conclusion: In high-level athletes who present chronic disabling mature posttraumatic myositis ossificans that interferes with their sports career, surgical excision of the heterotopic mass results in effective clinical improvement with return to sports and minimal postoperative risks., Level of Evidence: Case series, Level IV.

Background: the origin of chronic Achilles tendinopathy (AT) is currently unclear and epidemiological factors, such as ethnicity, may be associated., Methods: intraoperative findings from the treatment of 865 Finnish and 156 Italian athletic patients with chronic Achilles tendon related pain were evaluated, retrospectively. The mean age was 34 years (range, 18 to 65 years) in the Finnish and 29 years (range, 17-63 years) in the Italian patients. In total, 786 patients were males and 226 females of which 84 and 87% Finnish, respectively. Data were collected, retrospectively from patient records. The differences in the frequencies of operative findings were assessed for statistical significance., Results: retrocalcaneal bursitis, partial tear and chronic paratenonitis were the most prevalent findings in patients with chronic AT undergoing surgery. Tendinosis and chronic paratenonitis were significantly (p=0.011) more common in Finnish athletes. Italian patients exhibited significantly (p<0.001) more insertional calcific tendinopathy (heel spurs) and prominent posterosuperior calcaneal corners (Haglund's heel)., Conclusion: ethnicity appears to be associated with specific characteristics of overuse-related Achilles tendon pathology. This is an issue that should be considered in the planning of genetic research on AT.

Purpose: Hamstring 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., Methods: In 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., Results: Occasionally, 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., Conclusions: Evidence-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 Evidence: IV.

Background: Proximal hamstring tears can be associated with chronic disability related to the unusual formation of heterotopic ossifications. The role for operative intervention in these circumstances has not been clearly defined., Purpose/hypothesis: The purpose of this study was to describe the surgical management of young athletes who had chronic disability related to proximal hamstring ossifications after eccentric load injuries. The hypothesis was that after surgical excision of posttraumatic heterotopic ossifications at the proximal hamstrings with concomitant repair of the tendons to the ischium, significant functional improvement with low risk of postoperative complications can be expected at minimum 2-year follow-up., Study Design: Case series; Level of evidence, 4., Methods: The cases of 11 consecutive male athletes who developed chronic disability associated with heterotopic ossifications at the proximal hamstring muscles after sports-related tears were reviewed. During surgery, the ossified mass was meticulously excised, and the tendons were debrided and fixed to the ischium. At minimum 2-year follow-up, self-reported outcome was rated as excellent, good, moderate, or poor. Operative reports and office visits were reviewed. Activity level before the injury and at latest follow-up was graded with the Tegner scale., Results: The median age at injury was 17 years (range, 13-25 years). Sports activities included ice hockey, soccer, track and field athletics, and judo. Mean interval from injury to surgery was 45 months. The smallest ossified mass was 2 × 2 × 4 cm and the largest, 3 × 4 × 9 cm. Median follow-up was 4 years (range, 2-10 years). Six patients had excellent, 1 patient had good, and 4 patients had moderate outcomes; 7 of them were able to return to preinjury activities (Tegner score, 7-10). There were 2 cases of loss of skin sensation at the posterior femoral cutaneous nerve distribution, but neither patient described this as significantly interfering with any activity. All patients had symmetric side-to-side single-legged hop test and a 5 out of 5 on hamstring muscle strength at latest follow-up., Conclusion: Heterotopic ossifications that develop at the proximal hamstrings after eccentric load injuries can be associated with significant chronic disability. These cases can be effectively treated by surgical excision of the ossified masses and concomitant debridement with suture fixation of the proximal hamstring tendons to the ischium. Return to preinjury activities is expected in the majority of these cases, with low postoperative risks., (© 2015 The Author(s).)

Background: proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting. Mainly affecting athletically active individuals, PHT is a considerable challenge for treating health care professionals., Purpose: this paper aims to concisely present the literature on PHT to guide health care professionals treating these patients and doing research on the subject., Methods: we reviewed the literature on PHT through literature search of scientific journal databases., Conclusions: as a tendinopathic pathology, it is a rather recently discovered exertion injury. As with other chronic tendon overuse injuries, current treatment strategies are unspecific with uncertain outcomes due to the unknown etiology of the tendon degeneration. Diagnostic features as well as both operative and non-operative treatments are evaluated from a clinical perspective, providing up to date information for clinicians and sports medicine therapists dealing with hamstring problems., Level of Evidence: V.

Background: Nonsurgical treatments for chronic Achilles tendinopathy (AT) results in unpredictable success rates. Surgical treatment may be chosen as reports show mostly encouraging but variable success rates depending on the pathology. The distribution of surgically confirmed pathologies in AT is largely unknown., Purpose: To ascertain the distributions of macroscopically observed anomalies in participants undergoing surgical treatment for chronic AT., Study Design: Case series; Level of evidence, 4., Methods: The main macroscopic pathologies of 1661 chronic Achilles tendon overuse injuries, which were diagnosed and surgically treated by a single surgeon, were reviewed. The surgeries were performed on professional and recreational athletes during the years 1976-1980, 1986-1990, 1996-2000, and 2006-2010. Surgical diagnoses, along with age- and sport-specific characteristics, were collected retrospectively from patient records., Results: The relative proportion of tendinosis increased during the study period from 4.2% to 21%, and paratenonitis decreased from 50% to 26%. Retrocalcaneal pathologies were the most common surgically confirmed lesions at 30%, while the mean age at surgery increased by 11 years over the entire study period., Conclusion: Surgically confirmed pathologies in and around the Achilles tendon showed coherent changes, chronic paratenonitis, and retrocalcaneal problems as the most prevalent findings. The classification of midportion and insertional tendinopathy and retrocalcaneal bursitis in AT should strictly be used as a clinical diagnosis. During surgical evaluations, the diagnosis is further clarified as more specific pathologies may be identified.

Compartment syndrome is a surgical emergency that usually occurs as a sequel to high-energy trauma. We report an uncommon presentation of atraumatic compartment syndrome of the right foot involving the abductor hallucis muscle. A 15-year-old female presented with pain and mild swelling of the right foot after taking part in a school sports activity. Compartment syndrome was diagnosed, >2 months of conservative treatment failed to improve her symptoms, and surgical release and debridement were performed. Our clinical experience demonstrates that compartment syndrome of the foot may occur after mild sports activity in physically inactive children., (Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Triceps muscle tears requiring surgical treatment are uncommon injuries., Method: We present 10 cases, all of them were athletes. All these patients were treated surgically between 1993 and 2009. Three operations were performed in the acute phase and the rest seven cases an average of 6 months (range 3-12 months) after the primary injury. The mean follow-up period after surgery was 6 years (range 2-9 years)., Results: The result was evaluated to be excellent in five cases, good in four, and fair in one patient. All except one patient were able to resume full training., Conclusion: Our results show that surgical treatment seems to be beneficial in severe triceps tears even after failed conservative treatment.

Acute intracompartmental pressure syndrome is a surgical emergency situation. The syndrome is rare and is most commonly associated with a high-energy trauma. It may occur also without trauma, for instance in muscular overloading. The syndrome should be suspected, when a child suffers from acute foot pain. The treatment is immediate compartment release surgery. A delay can be critical, because complications may remain persistent.

Hamstring injuries are common, especially among athletes. A complete rupture of the proximal hamstring muscles requires surgical intervention. In this report we describe a reconstruction method for a complete proximal hamstring rupture using fascia lata autograft augmentation in addition to suture anchors. This method can be advocated in cases in which the primary repair has failed or in chronic injuries where a large defect between the distally retracted tendons and the ischial tuberosity prevents anatomic reinsertion. In our technique, a muscle-tendon flap is first created from the retracted tendon stump, turned proximally, and fixed to the ischial tuberosity by suture anchors. The fascia lata graft is then fixed from the midpart to the ischial tuberosity via the same sutures. The other sleeve of the graft is folded on the ventral side of the ruptured tendon stump and fixed by use of absorbable sutures. Then the other sleeve is folded on the dorsal side and fixed in the same manner. Finally, the fixation can still be reinforced with additional absorbable sutures passing through both sleeves of the graft, as well as the muscle-tendon bridge and the tendon stump.