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

PurposeIdentification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes.MethodsA literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes.ResultsMedical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism.ConclusionsPosture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors.Level of evidenceLiterature review and expert opinion, Level V.

Background Cancer survivorship care is traditionally performed in secondary care. Primary care is often involved in cancer management and could therefore play a more prominent role. Purpose To assess outcomes of cancer survivorship care in primary versus secondary care. Methods A systematic search of MEDLINE and EMBASE was performed. All original studies on cancer survivorship care in primary versus secondary care were included. A narrative synthesis was used for three distinctive outcomes: (1) clinical, (2) patient-reported, and (3) costs. Results Sixteen studies were included: 7 randomized trials and 9 observational studies. Meta-analyses were not feasible due to heterogeneity. Most studies reported on solid tumors, like breast (N = 7) and colorectal cancers (N = 3). Clinical outcomes were reported by 10 studies, patient-reported by 11, and costs by 4. No important differences were found on clinical and patient-reported outcomes when comparing primary- with secondary-based care. Some differences were seen relating to the content and quality of survivorship care, such as guideline adherence and follow-up tests, but there was no favorite strategy. Survivorship care in primary care was associated with lower societal costs. Conclusions Overall, cancer survivorship care in primary care had similar effects on clinical and patient-reported outcomes compared with secondary care, while resulting in lower costs. Implications for cancer survivors Survivorship care in primary care seems feasible. However, since the design and outcomes of studies differed, conclusive evidence for the equivalence of survivorship care in primary care is still lacking. Ongoing studies will help provide better insights.