Efficacy of Surgical Tenodesis for Treatment of Distal Semitendinosus Hamstring Tendon Injuries

Abstract

Background: Understanding the optimal management of distal semitendinosus hamstring injuries is critical for reducing pain, restoring preinjury function, maintaining knee stability, improving hamstring muscle strength, and minimizing the risk of complications and recurrence. To our knowledge, the outcomes of surgical tenodesis for distal semitendinosus hamstring injuries have not been previously reported. Hypothesis: Surgical tenodesis for injuries of the semitendinosus would enable return to preinjury level of sport with low risk of recurrence. Study Design: Case series; Level of evidence, 4. Methods: This prospective single-surgeon study included 13 professional athletes (12 men, 1 woman; mean age, 32 ± 8.2 years; mean body mass index, 26.7 ± 3.9 kg/m2) undergoing treatment for distal semitendinosus hamstring injuries with primary tenodesis to the distal semimembranosus. Indications for surgical tenodesis included distal semitendinosus tendon avulsion injury (n = 8) or residual tendon instability and hamstring weakness after semitendinosus graft harvest for anterior cruciate ligament reconstruction (n = 5). All study patients underwent a standardized postoperative rehabilitation program. The primary outcome was defined as time for return to sporting activity. Secondary outcomes were patient satisfaction, injury recurrence, and complications. The mean follow-up time was 17 months (range, 12-24 months) from date of surgery. Results: All study patients returned to their preinjury level of sporting activity. The mean time from the surgical intervention to return to full sporting activity was 15 ± 4.6 weeks. At 1-year follow-up, all study patients were still participating at their preinjury level of sporting activity, and 12 patients (92%) were very satisfied and 1 patient (8%) was satisfied about the outcomes of their surgery. No study patients had recurrence of the primary injury. No surgical complications, injury recurrence, or reoperations were observed within the follow-up period. Conclusion: Early return to sporting activity was seen after surgical tenodesis for distal semitendinosus hamstring injuries after acute trauma or residual symptoms following previous hamstring graft harvest, with high levels of patient satisfaction and low risk of recurrence at short-term follow-up.

Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making

“…Regarding distal semitendinosus injuries, Thompson et al 104 recently described a tenodesis of the semitendinosus to the semimembranosus in 13 professional athletes, noting that the athletes returned to sport at 15 6 4.6 weeks and all were participating in sport at 1-year follow-up. Distal semitendinosus injuries may also be treated by tendon excision and/or tenotomy or tendon stripping.…”

Surgical treatment of distal hamstring tendon injuries yield a higher return‐to‐sports rate: A systematic review

“…Of the 18 included studies, five were case series [2, 10, 24, 34, 39] and 13 were case reports [1, 3–5, 8, 15, 18, 22, 23, 26, 32, 35, 36]. Fifteen studies assessed the RTS‐R and RTS‐T [1–3, 5, 8, 10, 15, 18, 22, 24, 26, 32, 35, 36, 39], and only three the RTS‐R [4, 23, 34]. Only three studies evaluated patient‐reported outcomes [2, 24, 39].…”

“…Fifteen studies assessed the RTS‐R and RTS‐T [1–3, 5, 8, 10, 15, 18, 22, 24, 26, 32, 35, 36, 39], and only three the RTS‐R [4, 23, 34]. Only three studies evaluated patient‐reported outcomes [2, 24, 39].…”

“…There were 67 patients, 61 males and 6 females, with a mean age 30.6 years (range 19-44 years) and 68 distal hamstring tendon injuries. The most common sports activity while sustaining the injury was rugby (31.3%) [2,8,39], followed by soccer (22.4%) [3,15,18,23,24,32,34,39], American football (16.4%) [4,5,10,35] and baseball (14.9%) [10,35,36].…”

“…Among patients that underwent conservative treatment, 15 failed and had to be operated on (53.6%), all with distal semitendinosus tendon injuries [3,10,24,26]. Of the 54 patients who underwent surgical treatment (including the 15 patients with failed initial conservative management), suture anchor fixation was the technique of choice in 20 lesions (36.4%) [2,4,5,8,23,24, 36], tenodesis in 16 (29.1%) [3,24,26,39], tenectomy in 14 (25.5%) [10,34] and resorbable or nonabsorbable sutures material were preferred in 5 (9%) [4,15,22,24,32].…”