Incomplete avulsion of the proximal hamstrings
can be a severely debilitating injury that causes weakness, pain
while sitting and inability to run. The results of the surgical treatment
of 23 consecutive patients with such injuries at least two years
after surgery are described. The surgery consisted of the repair
of the hamstrings directly onto the ischial tuberosity. At review,
using a visual analogue scale (VAS, 0 to 100), pain while sitting improved
from a mean of 40 (0 to 100) to 64 (0 to 100) (p = 0.024), weakness
from a mean of 39 (0 to 90) to 76 (7 to 100) (p = 0.0001) and the
ability to run from a mean of 24 (0 to 88) to 64 (0 to 95) (p =
0.0001). According to a VAS, satisfaction was rated at a mean of
81 (0 to 100) and 20 patients (87%) would have the same procedure
again. Hamstring strength measured pre- and post-operatively had
improved significantly from a mean of 64% (0% to 95%) to 88% (50%
to 114%) compared with the normal side. Most of these patients with symptomatic incomplete hamstring
avulsions unresponsive to conservative treatment had an improved
outcome after surgical repair.
We tested four types of surgical
repair for load to failure and distraction in a bovine model of
Achilles tendon repair. A total of 20 fresh bovine Achilles tendons
were divided transversely 4 cm proximal to the calcaneal insertion
and randomly repaired using the Dresden technique, a Krackow suture,
a triple-strand Dresden technique or a modified oblique Dresden
technique, all using a Fiberwire suture. Each tendon was loaded
to failure. The force applied when a 5 mm gap was formed, peak load
to failure, and mechanism of failure were recorded. The resistance
to distraction was significantly greater for the triple technique
(mean 246.1 N (205 to 309) to initial gapping) than for the Dresden (mean
180 N (152 to 208); p = 0.012) and the Krackow repairs (mean 101
N (78 to 112; p <
0.001). Peak load to failure was significantly
greater for the triple-strand repair (mean 675 N (453 to 749)) than
for the Dresden (mean 327.8 N (238 to 406); p <
0.001), Krackow
(mean 223.6 N (210 to 252); p <
0.001) and oblique repairs (mean
437.2 N (372 to 526); p <
0.001). Failure of the tendon was the
mechanism of failure for all specimens except for the tendons sutured using
the Krackow technique, where the failure occurred at the knot. The triple-strand technique significantly increased the tensile
strength (p = 0.0001) and gap
