The 2020 London International Hamstring Consensus meeting was convened to improve our understanding and treatment of hamstring injuries. The multidisciplinary consensus panel included 14 International specialists on the management of hamstring injuries. The Delphi consensus process consisted of two rounds of surveys which were completed by 19 surgeons from a total of 106 participants. Consensus on individual statements was regarded as over 70% agreement between panel members. The consensus group agreed that the indications for operative intervention included the following: gapping at the zone of injury (86.9%); high functional demands of the patient (86.7%); symptomatic displaced bony avulsions (74.7%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (71.4%). Panel members agreed that surgical intervention had the capacity to restore anatomy and function, while reducing the risk of injury recurrence (86.7%). The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help to further standardise the treatment of hamstring injuries and facilitate decision-making in the surgical treatment of these injuries

The jackaling position within rugby has not been previously described as a mechanism for proximal hamstring injuries. This prospective single surgeon study included 54 professional rugby players (mean age 26 ± 4.8 years) undergoing acute primary surgical repair of complete, proximal hamstring avulsion injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardised postoperative rehabilitation programme. Predefined outcomes were recorded at regular intervals. Mean follow-up time was 17 months (range, 12 months to 24 months) from date of surgery. 51 patients (94.4%) returned to their pre-injury level of sporting activity. Mean time from surgical repair to full sporting activity was 7 months (range, 4 months to 12 months). Zero patients had recurrence of the primary injury. At 1 year after surgery compared to 3 months after surgery, patients had increased mean isometric hamstring muscle strength at 0° (98.4 ± 2.8% vs 88.1% ± 5.4%, p<0.001), 15° (95.9 ± 2.9 vs 88.2 ± 8.1%, p<0.001) and 45° (92.9% ± 4.1% vs 76.8% ± 9.7%, p<0.001), higher mean lower extremity functional scores (77.0 ± 2.3 vs 64.5 ± 4.5, p<0.001), and improved Marx activity rating scores (14.3 ± 1.5 vs 10.7 ± 2.6, p<0.001). Acute surgical repair of proximal hamstring avulsion injuries caused by the contact jackaling position produces high patient satisfaction, high return to preinjury level of sporting activity, with low risk of recurrence at short-term follow-up

The August 2012 Hip & Pelvis Roundup. 360. looks at: whether cemented hip replacement might be bad for your health; highly cross-linked polyethylene; iHOT-33 - a new hip outcome measure; hamstring injuries; total hip replacement; stemmed metal-on-metal THR; bipolar hemiarthroplasty, neuromuscular disease and dislocation; the high risk of secondary hemiarthroplasty; and whether we have to repair the labrum after all?

The October 2014 Knee Roundup. 360 . looks at: microfracture equivalent to OATS; examination better than MRI in predicting hamstrings re-injury; a second view on return to play with hamstrings injuries; dislocation risks in the Oxford Unicompartmental Knee; what about the tibia?; getting on top of lateral facet pain post TKR; readmission in TKR; patient-specific instrumentation; treating infrapatellar saphenous neuralgia; and arthroscopy in the middle-aged

Both acute and chronic hamstring injuries are disabling injuries, and occur almost entirely to elite athletes. We report our experience in the management of injuries of this location. Twenty seven patients (29 injuries) were included in the present study. They completed a questionnaire detailing their pre-injury activity, injury mechanism, rehabilitation and a subjective assessment of their recovery. At clinical examination pain and hip motion were evaluated. Hamstring injuries predominantly affect males on the left side. Most procedures carried out were explorations with limited debridement and suture of the tendon. One third of patients felt they had returned to 100% of their pre-injury level, and 33% felt they had returned to 80–90% of their pre-injury level, the rest varied between < 20–80%. 45% gave a value of zero on the visual analogue pain scale independent of activity, those who gave a value above this had pain during active sports but not at rest. Early repair leads to a much better recovery of muscle function, especially when dealing with complete avulsions. Lesions to the origin of the hamstring can be successfully managed if a high suspicion for the condition exerted

Background & Purpose. The co-ordinated contraction of the kinetic chain is responsible for the dissipation of force. Weakness in the kinetic chain, such as the posterior oblique sling (POS), may increase the demand on additional muscles, such as the hamstrings, to compensate. The lumbar extensors may be particularly vulnerable in the kinetic chain, as they appear difficult to strengthen due to the dominant hip extensors. Therefore, this study aimed to investigate whether participants with a history of hamstring injuries presented with low back pain because of greater deficits in lumbar extensor strength, and impaired co-ordination of the POS. Methods. Twenty male footballers were recruited (n: Injured- 9, Controls- 11). Isolated lumbar extension strength, low back pain, and the contraction time of muscles within the POS during a hip extension test were recorded. Participants were then grouped in either the injury or control group. Conclusion. No differences were observed for lumbar extensor strength (P > 0.05) or the onset of muscular contraction (P > 0.05), though 95% confidence intervals revealed the difference in gluteus maximus onset time (−0.11 – 1.06 s) could be large and may have clinical importance. Descriptive data highlighted the prevalence of back pain was 40% greater in HSI participants. Conflicts of interest. None. Sources of funding. This research was funded by the Wellcome Trust as part of their biomedical vacation award

Aims

Avulsion of the proximal hamstring tendon origin can result in significant functional impairment, with surgical re-attachment of the tendons becoming an increasingly recognized treatment. The aim of this study was to assess the outcomes of surgical management of proximal hamstring tendon avulsions, and to compare the results between acute and chronic repairs, as well as between partial and complete injuries.

The June 2012 Hip & Pelvis Roundup³⁶⁰ looks at: whether metal-on-metal is really such a disaster; resurfacings with unexplained pain; large heads and high ion levels; hip arthroscopy for FAI; the inaccuracy of clinical tests for impingement; arthroscopic lengthening of iliopsoas; the OA hip; the injured hamstring – football’s most common injury; an algorithm for hip fracture surgery; and sparing piriformis at THR.