Surgical Repair of Distal Biceps Femoris Avulsion Injuries in Professional Athletes

Abstract

Background: Understanding the optimal management of distal biceps femoris avulsion injuries is critical for restoring preinjury function, restoring hamstring muscle strength, increasing range of motion, and minimizing risk of complications and recurrence. Due to the rarity of these injuries, prognosis and outcomes within the literature are limited to case reports and small case series. Purpose: To assess the effect of surgical repair for acute distal avulsion injuries of the biceps femoris tendon on (1) return to preinjury level of sporting function and (2) time to return to preinjury level of sporting function, patient satisfaction, and complications. Study Design: Case series; Level of evidence, 4. Methods: This prospective single-surgeon study included 22 elite athletes (18 men [82%], 4 women [18%]; mean age, 26 years; age range, 17-35 years; mean body mass index, 25.3 ± 4.1 kg/m2) undergoing primary suture anchor repair of avulsion injuries of the distal biceps femoris confirmed on preoperative magnetic resonance imaging. Predefined outcomes relating to time for return to sporting activity, patient satisfaction, complications, and injury recurrence were recorded at regular intervals after surgery. Minimum follow-up time was 12 months (range, 12.0-26.0 months) from the date of surgery. Results: The mean time from injury to surgical intervention was 12 days (range, 2-28 days). All study patients returned to their preinjury level of sporting activity, predominately professional soccer or rugby. Mean time from surgical intervention to return to full sporting activity was 16.7 ± 8.7 weeks. At 1- and 2-year follow-up, all study patients were still participating at their preinjury level of sporting activity. There was no incidence of primary injury recurrence, and no patients required further operation to the biceps origin. Conclusion: Surgical repair of acute avulsion injuries of the distal biceps femoris facilitated early return to preinjury level of function with low risk of recurrence, low complication rate, and high patient satisfaction in elite athletes. Suture anchor repair of these injuries should be considered a reliable treatment option in athletes with high functional demands to permit an early return to sport with restoration of hamstring strength.

Distal Biceps Femoris Tendon Tear in an Active-Duty Soldier: A Case Report and Review of the Literature

“…At 1-year follow-up, 91% were very satisfied with their outcomes, and there was no injury recurrence or need for secondary procedures. 3 Kayani et al reported on a series of 34 professional athletes who underwent suture repair of distal biceps femoris tears involving the myotendinous junction. 11 All athletes were able to return to preinjury level of sport at a mean of 11.7 weeks.…”

“…8 Nonetheless, good clinical results have been reported with suture anchor repair of avulsion injuries, with return to preinjury level of sport seen in all 22 professional athletes in one case series. 3 However, intratendinous ruptures are exceedingly rare, with only one case described in a series of 18 distal hamstring ruptures by Lempainen et al 2 As such, information on management and outcomes following this type of injury is lacking.…”

“…1,2 Its anatomy is unique in that the long and short heads have separate innervations, the tibial and common peroneal nerves, respectively, with the two tendons coalescing to insert along proximal, medial, and distal footprints on fibular head as well as the proximal lateral tibia. 3,4 The biceps femoris is the strongest flexor of the hamstring group, responsible for up to 85% of knee flexion strength. 5,6 In addition, it functions as a dynamic stabilizer and is an integral component of the posterolateral corner of the knee.…”

London International Consensus and Delphi study on hamstring injuries part 2: operative management

“…MTJ injuries have been traditionally treated non-operatively with varying success in return to sport timing and recurrence of injury rates. There is evidence that surgical repair in proximal and distal high-grade MTJ injuries can return athletes to their previous level of sport with a low risk of recurrence 20 24 25. Ayuob et al 20 have shown in 41 high-level athletes with severe-grade proximal biceps femoris MTJ injuries that 100% return to preinjury level at 13.4±5.1 weeks.…”

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

“… 10 , 11 , 20 , 38 , 40 Less commonly, hamstring injuries involve the distal hamstring muscle complex, and more rarely they include the distal semitendinosus. 26 , 37 …”