The quality of studies included is low. Surgical repair of proximal hamstring avulsions appears to result in a subjective highly satisfying outcome. However, decreased strength, residual pain, and decreased activity level were reported by a relevant number of patients. Minimal to no differences in outcome of acute and delayed repairs were found. Limited evidence suggests that an Achilles allograft reconstruction yields results comparable with primary repair in delayed cases where primary repair is not possible. High-level studies are required to confirm these findings.

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på link.springer.com: http://dx.doi.org/10.1007/s00167-013-2744-0 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. Purpose: The anatomical appearance of the hamstring muscle complex (HMC) was studied to 2 provide hypotheses for the hamstring injury pattern and to provide reference values of 3 origin dimensions, muscle length, tendon length, musculotendinous junction (MTJ) length as 4 well as width and length of a tendinous inscription in the semitendinosus muscle known as 5 the raphe. 6Methods: Fifty-six hamstring muscle groups were dissected in prone position from 29 human 7 cadaveric specimens with a median age of 71.5 years (range 45 to 98). 8Results: Data pertaining to origin dimensions, muscle length, tendon length, MTJ length and 9 length as well as width of the raphe were collected. Besides these data we also encountered 10 interesting findings that might lead to a better understanding of the hamstring injury 11 pattern. These include overlapping proximal and distal tendons of both the long head of the 12 biceps femoris muscle (BFlh) and the semimembranosus muscle (SM), a twist in the proximal 13 SM tendon and a tendinous inscription (raphe) in the semitendinosus muscle (ST) present in 14 96% of specimens. 15 Conclusion:No obvious hypothesis can be provided purely based on either muscle length, 16 tendon length or MTJ length. However, it is possible that overlapping proximal and distal 17 tendons as well as muscle architecture leading to a resultant force not in line with the 18

Time to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited.