Nonoperative treatment of acute or chronic complete ruptures of the proximal hamstring tendons leads to functional impairment in sports activities. The objective of the study was to evaluate the functional status after primary and delayed surgical treatment including objective (isokinetic hamstring and quadriceps muscle testing, hamstring flexibility) and subjective parameters (overall satisfaction, postoperative sports level). A total of eight patients (six male, two female) with an average age of 40.0 years (range 23-60) were treated operatively by refixation of the ruptured tendons in anatomical position using a suture anchor system. Six patients were treated within 3 weeks after trauma, while two patients were operated after delayed diagnosis of more than 2 months. The average clinical follow-up was 33.3 months (range 12-59). Overall, at minimum follow-up of 20 months, all patients were satisfied with the functional outcome and would undergo operative treatment again. At follow-up, seven patients could return to their preinjury sports level. In two patients, however, we noticed a delayed return to preinjury sports level of more than 24 months. The peak torque of the operated hamstrings in isokinetic muscle testing was 88.3% (range 62.9-113.8), as compared to the contralateral extremity. The ratio of hamstring to quadriceps muscle strength was on average 0.55 (range 0.44-0.66; injured side) versus 0.61 (range 0.52-0.68; uninjured side). Measurement of hamstring flexibility showed no difference to the contralateral hamstrings. In cases of timely diagnosis, surgical treatment is the standard treatment for complete ruptures of the proximal hamstring tendons in patients with ambitions inclined toward sports. The suture anchor system implements an elegant and effective technique for the treatment of such lesions.

IV.

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An avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion is defined as a root tear. In clinical practice, the incidence of these lesions is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a total meniscectomy. Clinical studies documented progredient arthritic changes following root tears, thereby supporting basic science studies. The clinical diagnosis is limited by unspecific symptoms. In addition to the diagnostic arthroscopy, MRI is considered to be the gold standard of diagnosis of a meniscal root tear. Three different direct MRI signs for the diagnosis of a meniscus root tear have been described: Radial linear defect in the axial plane, vertical linear defect (truncation sign) in the coronal plane, and the so-called ghost meniscus sign in the sagittal plane. Meniscal extrusion is also considered to be an indirect sign of a root tear, but is less common in lateral root tears. During arthroscopy, the function of the meniscus root must be assessed by probing. However, visualization of the meniscal insertions is challenging. Refixation of the meniscal root can be performed using a transtibial pull-out suture, suture anchors, or side-to-side repair. Several short-term studies reported good clinical results after medial or lateral root repair. Nevertheless, MRI and second-look arthroscopy revealed high rates of incomplete or absent healing, especially for medial root tears. To date, most studies are case series with short-term follow-up and level IV evidence. Outerbridge grade 3 or 4 chondral lesions and varus malalignment of >5° were found to predict an inferior clinical outcome after medial meniscus root repair. Further research is needed to evaluate long-term results and to define evident criteria for meniscal root repair.