title: Distal semitendinosus ruptures in elite-level athletes: low success rates of nonoperative treatment.
abstract: BACKGROUND
  No case series of isolated complete rupture of the distal semitendinosus tendon have been reported previously.
  
  
  OBJECTIVE
  This study was undertaken to increase awareness and report the authors' treatment experience, particularly the less than favorable results of nonoperative initial treatment.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The authors identified 25 cases of distal semitendinosus tendon rupture over a 14-year period (1991-2005). All players were male professional (20), collegiate (4), or high-level amateur (1) athletes. Follow-up of 17 cases averaged 13 months (range, 4-55), and 8 patients were lost to follow-up. Eight Major League Baseball, 8 National Football League, and 1 National Hockey League athletes were included in this study. Early treatment experience always involved nonoperative treatment, including rest, modalities, and rehabilitation exercises, followed by functional progression. "Recovery" was defined by clinical criteria including clearance to return to play. Failure to improve with nonoperative treatment, and thus requiring surgical treatment, was deemed a failure of nonoperative treatment. There were 12 players who had initial nonoperative treatment. The authors had later experience with 5 players who had surgery early in the acute phase in hopes of speeding return to competition.
  
  
  RESULTS
  In the nonoperative treatment group (12), 7 players recovered at an average of 10.4 weeks (range, 3-35). Five of these players (42%) failed initial nonoperative treatment (mean, 16.8 weeks) and subsequently had surgery to resect the torn tendon and surrounding scar tissue. These 5 players recovered at an average of 12.8 weeks postoperatively. In the acute surgery group, 5 players had surgery to resect the torn tendon and scar tissue within 4 weeks of injury. The acute-phase group had an average recovery of 6.8 weeks after surgery.
  
  
  CONCLUSIONS
  Distal semitendinosus ruptures frequently (42%) do not recover after nonoperative treatment. Acute surgical resection of the completely ruptured semitendinosus tendon may speed recovery when the athlete has a tender mass and difficulty extending the knee fully in the stance phase of gate. Future investigation is warranted to compare the long-term outcome of nonoperative treatment with that after acute surgery.
authors.affiliation: The Carrell Clinic, 9301 N. Central Expressway, Dallas, TX 75231, USA. dcooper@trlx.com
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Cooper
authors.forename: John E
authors.initials: JE
authors.lastname: Conway
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000628:therapy*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012421:Rupture / Q000453:epidemiology / Q000628:therapy; D013708:Tendon Injuries / Q000503:physiopathology* / Q000628:therapy; D013781:Texas / Q000453:epidemiology; D055815:Young Adult