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Abduction in Proximal Hamstring Tendon Avulsion Injury Mechanism

A Report on 3 Athletes

van der Made, Anne D. MD*,†,‡; Peters, Rolf W. MD†,‡,§; Verheul, Claire PhD†,¶; Maas, Mario MD, PhD†,‡,‖; Kerkhoffs, Gino M. MD, PhD*,†,‡

Clinical Journal of Sport Medicine: November 2019 - Volume 29 - Issue 6 - p e76–e79
doi: 10.1097/JSM.0000000000000543
Case Report
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Abstract: Proximal hamstring tendon avulsions are typically sustained during forced hip hyperflexion combined with knee extension. We present 3 cases of athletes with a proximal hamstring tendon avulsion caused by an alternative injury mechanism that also involves a considerable hip abduction component (flexion-abduction injury mechanism). All cases had at least one concurrent injury of the medial thigh muscles, either on the ipsilateral or contralateral side. The 2 elite athletes with this injury mechanism returned to sport at preinjury level relatively quickly. A history of the flexion-abduction mechanism should raise suspicion of a hamstring tendon avulsion with concomitant injury of the medial thigh muscles. The magnetic resonance imaging (MRI) protocol should include both legs, and any concurrent injury may need to be addressed as well. In future studies, it would be interesting to investigate whether injury mechanism holds prognostic value in proximal hamstring tendon avulsions.

*Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands;

Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, the Netherlands;

Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands;

§Department of Trauma Surgery, Academic Medical Center, Amsterdam, the Netherlands;

ManualFysion, Amsterdam, the Netherlands; and

Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.

Corresponding Author: Anne D. van der Made, MD, Department of Orthopaedic Surgery, Academic Medical Center, PO Box 22660, 1100DD Amsterdam, the Netherlands (a.d.vandermade@amc.uva.nl).

The authors report no conflict of interests.

Received May 24, 2017

Accepted August 10, 2017

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