title: Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes.
abstract: BACKGROUND
  Hamstring injury is the most common muscular lesion in athletes. The conservative treatment is well described, and surgical management is often indicated for proximal tendinous avulsions. To our knowledge, no surgical treatment has been proposed for failure of conservative treatment in musculotendinous hamstring lesions.
  
  
  OBJECTIVE
  To describe the surgical management of proximal and distal hamstring musculotendinous junction lesions in professional athletes after failure of conservative treatment.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A consecutive series of 10 professional athletes, including 4 soccer players, 4 rugby players, and 2 handball players, underwent surgical intervention between October 2010 and June 2014 for the treatment of recurrent musculotendinous hamstring injuries. All athletes had failed at least 3 months of conservative treatment for a recurrent musculotendinous hamstring injury. Surgical resection of the musculotendinous scar tissue was performed using a longitudinal muscular suture. Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at the 3-month follow-up, and a final phone interview was completed to determine recurrence of hamstring injury and return to previous level of play.
  
  
  RESULTS
  The mean age at surgery was 25.2 years (range, 19-35 years). The musculotendinous hamstring lesions involved 8 semitendinosus and 2 biceps femoris, with 6 injuries located proximally and 4 distally. Conservative treatment lasted a mean 5.1 months (range, 3-9 months) after last recurrence, and the patients had an average of 2.7 (range, 2-5) separate incidents of injury recurrence before surgical intervention was decided upon. At the 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. All 10 patients returned to the same level of play at a mean 3.4 months (range, 2-5 months). At a mean follow-up of 28.7 months, none of the athletes had suffered a recurrence. No surgical complication was encountered.
  
  
  CONCLUSIONS
  In cases of failed conservative treatment of musculotendinous hamstring lesions, surgical intervention may be a viable treatment option in professional athletes and allows the patient to return to the same level of play.
authors.affiliation: Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sonnery-Cottet
authors.affiliation: Kansas City University, Kansas City, Missouri, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Daggett
authors.affiliation: Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Gardon
authors.affiliation: Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pupim
authors.affiliation: Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Clechet
authors.affiliation: Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Thaunat
keywords: hamstring; musculotendinous lesion; professional athlete; sports injuries