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Erschienen in: Die Unfallchirurgie 7/2021

18.06.2021 | Leitthema

Klinische Ergebnisse nach Refixation proximaler Hamstring-Sehnen-Rupturen unter Berücksichtigung verschiedener Ankersysteme

verfasst von: M. Irger, P. Forkel, Prof. Dr. A. B. Imhoff, L. Willinger

Erschienen in: Die Unfallchirurgie | Ausgabe 7/2021

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Zusammenfassung

Hintergrund

Verletzungen der ischiokruralen Muskulatur zählen zu den häufigsten Muskelverletzungen des Menschen, wobei der Abriss der proximalen Hamstring-Sehnen eine besonders schwerwiegende Form darstellt. Die operative Therapie dieser Verletzungen ist dem konservativen Management hinsichtlich Patientenzufriedenheit, Wiederherstellung der Muskelkraft und Funktion sowie „return to sports“ überlegen und deshalb Methode der Wahl.

Fragestellung

Darstellung und Vergleich der operativen Ergebnisse nach Versorgungen mit Titan‑, Polyetheretherketon(PEEK)- oder „All-suture“-Anker.

Material und Methoden

Es wurde eine systematische Literatursuche in der Medizindatenbank PubMed durchgeführt, und die Ergebnisse wurden zusammengefasst.

Ergebnisse

Alle Systeme zeigen vergleichbare biomechanische Elongations- sowie Maximallastwerte. Operationen mit diesen Ankern resultieren in guten klinischen Ergebnissen und weisen niedrige Komplikations- und eine hohe Return-to-sports-Raten auf. Die Patientenzufriedenheit nach Hamstring-Sehnen-Repair beträgt über 90 % und die Return-to-sports-Raten 80–100 %. Die Muskelkraft wird im Vergleich zur Gegenseite zu etwa 80–90 % wiederhergestellt.

Schlussfolgerung

Alle Ankertypen sind sicher anwendbar, und ein expliziter Vorteil für ein Ankersystem konnte bis dato nicht nachgewiesen werden.
Literatur
1.
Zurück zum Zitat Aldridge SE, Heilpern GN, Carmichael JR et al (2012) Incomplete avulsion of the proximal insertion of the hamstring: outcome two years following surgical repair. J Bone Joint Surg Br 94:660–662PubMed Aldridge SE, Heilpern GN, Carmichael JR et al (2012) Incomplete avulsion of the proximal insertion of the hamstring: outcome two years following surgical repair. J Bone Joint Surg Br 94:660–662PubMed
2.
Zurück zum Zitat Arner JW, Freiman H, Mauro CS et al (2019) Functional results and outcomes after repair of partial proximal hamstring avulsions at midterm follow-up. Am J Sports Med 47:3436–3443PubMed Arner JW, Freiman H, Mauro CS et al (2019) Functional results and outcomes after repair of partial proximal hamstring avulsions at midterm follow-up. Am J Sports Med 47:3436–3443PubMed
3.
Zurück zum Zitat Barnett AJ, Negus JJ, Barton T et al (2015) Reattachment of the proximal hamstring origin: outcome in patients with partial and complete tears. Knee Surg Sports Traumatol Arthrosc 23:2130–2135PubMed Barnett AJ, Negus JJ, Barton T et al (2015) Reattachment of the proximal hamstring origin: outcome in patients with partial and complete tears. Knee Surg Sports Traumatol Arthrosc 23:2130–2135PubMed
4.
Zurück zum Zitat Best R, Eberle J, Beck F et al. (2019) Functional impairment after successful surgical reconstruction for proximal hamstring avulsion. Int Orthop 43:2341–2347PubMed Best R, Eberle J, Beck F et al. (2019) Functional impairment after successful surgical reconstruction for proximal hamstring avulsion. Int Orthop 43:2341–2347PubMed
5.
Zurück zum Zitat Birmingham P, Muller M, Wickiewicz T et al (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg Am 93:1819–1826PubMed Birmingham P, Muller M, Wickiewicz T et al (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg Am 93:1819–1826PubMed
6.
Zurück zum Zitat Blakeney WG, Zilko SR, Edmonston SJ et al (2017) A prospective evaluation of proximal hamstring tendon avulsions: improved functional outcomes following surgical repair. Knee Surg Sports Traumatol Arthrosc 25:1943–1950PubMed Blakeney WG, Zilko SR, Edmonston SJ et al (2017) A prospective evaluation of proximal hamstring tendon avulsions: improved functional outcomes following surgical repair. Knee Surg Sports Traumatol Arthrosc 25:1943–1950PubMed
7.
Zurück zum Zitat Bodendorfer BM, Curley AJ, Kotler JA et al. (2018) Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis. Am J Sports Med 46:2798–2808PubMed Bodendorfer BM, Curley AJ, Kotler JA et al. (2018) Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis. Am J Sports Med 46:2798–2808PubMed
8.
Zurück zum Zitat Bowman EN, Marshall NE, Gerhardt MB et al (2019) Predictors of clinical outcomes after proximal hamstring repair. Orthop J Sports Med 7:2325967118823712PubMedPubMedCentral Bowman EN, Marshall NE, Gerhardt MB et al (2019) Predictors of clinical outcomes after proximal hamstring repair. Orthop J Sports Med 7:2325967118823712PubMedPubMedCentral
9.
Zurück zum Zitat Bowman KF Jr., Cohen SB, Bradley JP (2013) Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 41:1363–1371PubMed Bowman KF Jr., Cohen SB, Bradley JP (2013) Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 41:1363–1371PubMed
10.
Zurück zum Zitat Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13:411–418PubMed Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13:411–418PubMed
11.
Zurück zum Zitat Chahal J, Bush-Joseph CA, Chow A et al (2012) Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal? Am J Sports Med 40:2325–2330PubMed Chahal J, Bush-Joseph CA, Chow A et al (2012) Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal? Am J Sports Med 40:2325–2330PubMed
12.
Zurück zum Zitat Chang JS, Kayani B, Plastow R et al (2020) Management of hamstring injuries: current concepts review. Bone Joint J 102-b:1281–1288PubMed Chang JS, Kayani B, Plastow R et al (2020) Management of hamstring injuries: current concepts review. Bone Joint J 102-b:1281–1288PubMed
13.
Zurück zum Zitat Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15:350–355PubMed Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15:350–355PubMed
14.
Zurück zum Zitat Cohen SB, Rangavajjula A, Vyas D et al (2012) Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 40:2092–2098PubMed Cohen SB, Rangavajjula A, Vyas D et al (2012) Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 40:2092–2098PubMed
15.
Zurück zum Zitat De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 174:393–399PubMed De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 174:393–399PubMed
16.
Zurück zum Zitat Degen RM (2019) Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries. Curr Rev Musculoskelet Med 12:138–146PubMedPubMedCentral Degen RM (2019) Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries. Curr Rev Musculoskelet Med 12:138–146PubMedPubMedCentral
17.
Zurück zum Zitat Domb BG, Linder D, Sharp KG et al (2013) Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2:e35–e39PubMedPubMedCentral Domb BG, Linder D, Sharp KG et al (2013) Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2:e35–e39PubMedPubMedCentral
18.
Zurück zum Zitat Feucht MJ, Plath JE, Seppel G et al (2015) Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 23:2576–2582PubMed Feucht MJ, Plath JE, Seppel G et al (2015) Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 23:2576–2582PubMed
19.
Zurück zum Zitat Fletcher AN, Lau BC, Mather RC 3rd (2020) Endoscopic proximal hamstring tendon repair for nonretracted tears: an anatomic approach and repair technique. Arthrosc Tech 9:e483–e491PubMedPubMedCentral Fletcher AN, Lau BC, Mather RC 3rd (2020) Endoscopic proximal hamstring tendon repair for nonretracted tears: an anatomic approach and repair technique. Arthrosc Tech 9:e483–e491PubMedPubMedCentral
20.
Zurück zum Zitat Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36:104–109PubMed Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36:104–109PubMed
21.
Zurück zum Zitat Gerhardt MB, Assenmacher BS, Chahla J (2019) Proximal hamstring repair: a biomechanical analysis of variable suture anchor constructs. Orthop J Sports Med 7:2325967118824149PubMedPubMedCentral Gerhardt MB, Assenmacher BS, Chahla J (2019) Proximal hamstring repair: a biomechanical analysis of variable suture anchor constructs. Orthop J Sports Med 7:2325967118824149PubMedPubMedCentral
22.
Zurück zum Zitat Hamming MG, Philippon MJ, Rasmussen MT et al (2015) Structural properties of the intact proximal hamstring origin and evaluation of varying avulsion repair techniques: an in vitro biomechanical analysis. Am J Sports Med 43:721–728PubMed Hamming MG, Philippon MJ, Rasmussen MT et al (2015) Structural properties of the intact proximal hamstring origin and evaluation of varying avulsion repair techniques: an in vitro biomechanical analysis. Am J Sports Med 43:721–728PubMed
23.
Zurück zum Zitat Irger M, Willinger L, Lacheta L et al. (2020) Proximal hamstring tendon avulsion injuries occur predominately in middle-aged patients with distinct gender differences: epidemiologic analysis of 263 surgically treated cases. Knee Surg Sports Traumatol Arthrosc 28:1221–1229PubMed Irger M, Willinger L, Lacheta L et al. (2020) Proximal hamstring tendon avulsion injuries occur predominately in middle-aged patients with distinct gender differences: epidemiologic analysis of 263 surgically treated cases. Knee Surg Sports Traumatol Arthrosc 28:1221–1229PubMed
24.
Zurück zum Zitat Kurowicki J, Novack TA, Simone ES et al (2020) Short-term outcomes following endoscopic proximal hamstring repair. Arthroscopy 36:1301–1307PubMed Kurowicki J, Novack TA, Simone ES et al (2020) Short-term outcomes following endoscopic proximal hamstring repair. Arthroscopy 36:1301–1307PubMed
25.
Zurück zum Zitat Lefevre N, Bohu Y, Naouri JF et al (2013) Returning to sports after surgical repair of acute proximal hamstring ruptures. Knee Surg Sports Traumatol Arthrosc 21:534–539PubMed Lefevre N, Bohu Y, Naouri JF et al (2013) Returning to sports after surgical repair of acute proximal hamstring ruptures. Knee Surg Sports Traumatol Arthrosc 21:534–539PubMed
26.
Zurück zum Zitat Lempainen L, Banke IJ, Johansson K et al (2015) Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc 23:2449–2456PubMed Lempainen L, Banke IJ, Johansson K et al (2015) Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc 23:2449–2456PubMed
27.
Zurück zum Zitat Lempainen L, Sarimo J, Heikkilä J et al (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40:688–691PubMedPubMedCentral Lempainen L, Sarimo J, Heikkilä J et al (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40:688–691PubMedPubMedCentral
29.
Zurück zum Zitat Piposar JR, Vinod AV, Olsen JR et al (2017) High-grade partial and retracted (〈2 cm) proximal hamstring ruptures: nonsurgical treatment revisited. Orthop J Sports Med 5:2325967117692507PubMedPubMedCentral Piposar JR, Vinod AV, Olsen JR et al (2017) High-grade partial and retracted (〈2 cm) proximal hamstring ruptures: nonsurgical treatment revisited. Orthop J Sports Med 5:2325967117692507PubMedPubMedCentral
30.
Zurück zum Zitat Pombo M, Bradley JP (2009) Proximal hamstring avulsion injuries: a technique note on surgical repairs. Sports Health 1:261–264PubMedPubMedCentral Pombo M, Bradley JP (2009) Proximal hamstring avulsion injuries: a technique note on surgical repairs. Sports Health 1:261–264PubMedPubMedCentral
31.
Zurück zum Zitat Rust DA, Giveans MR, Stone RM et al (2014) Functional outcomes and return to sports after acute repair, chronic repair, and allograft reconstruction for proximal hamstring ruptures. Am J Sports Med 42:1377–1383PubMed Rust DA, Giveans MR, Stone RM et al (2014) Functional outcomes and return to sports after acute repair, chronic repair, and allograft reconstruction for proximal hamstring ruptures. Am J Sports Med 42:1377–1383PubMed
32.
Zurück zum Zitat Ryan MK, Beason DP, Fleisig GS et al (2019) Portal placement and biomechanical performance of endoscopic proximal hamstring repair. Am J Sports Med 47:2985–2992PubMed Ryan MK, Beason DP, Fleisig GS et al (2019) Portal placement and biomechanical performance of endoscopic proximal hamstring repair. Am J Sports Med 47:2985–2992PubMed
33.
Zurück zum Zitat Sallay PI, Friedman RL, Coogan PG et al (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24:130–136PubMed Sallay PI, Friedman RL, Coogan PG et al (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24:130–136PubMed
34.
Zurück zum Zitat Sandmann GH, Hahn D, Amereller M et al (2016) Mid-term functional outcome and return to sports after proximal hamstring tendon repair. Int J Sports Med 37:570–576PubMed Sandmann GH, Hahn D, Amereller M et al (2016) Mid-term functional outcome and return to sports after proximal hamstring tendon repair. Int J Sports Med 37:570–576PubMed
35.
Zurück zum Zitat Sarimo J, Lempainen L, Mattila K et al (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115PubMed Sarimo J, Lempainen L, Mattila K et al (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115PubMed
36.
Zurück zum Zitat Shambaugh BC, Olsen JR, Lacerte E et al (2017) A comparison of nonoperative and operative treatment of complete proximal hamstring ruptures. Orthop J Sports Med 5:2325967117738551PubMedPubMedCentral Shambaugh BC, Olsen JR, Lacerte E et al (2017) A comparison of nonoperative and operative treatment of complete proximal hamstring ruptures. Orthop J Sports Med 5:2325967117738551PubMedPubMedCentral
37.
Zurück zum Zitat Skaara HE, Moksnes H, Frihagen F et al (2013) Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 41:2577–2584PubMed Skaara HE, Moksnes H, Frihagen F et al (2013) Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 41:2577–2584PubMed
38.
Zurück zum Zitat Stępień K, Śmigielski R, Mouton C et al (2019) Anatomy of proximal attachment, course, and innervation of hamstring muscles: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 27:673–684PubMed Stępień K, Śmigielski R, Mouton C et al (2019) Anatomy of proximal attachment, course, and innervation of hamstring muscles: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 27:673–684PubMed
39.
Zurück zum Zitat Subbu R, Benjamin-Laing H, Haddad F (2015) Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med 43:385–391PubMed Subbu R, Benjamin-Laing H, Haddad F (2015) Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med 43:385–391PubMed
40.
Zurück zum Zitat Willinger L, Siebenlist S, Lacheta L et al. (2020) Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up. Knee Surg Sports Traumatol Arthrosc 28:1230–1235PubMed Willinger L, Siebenlist S, Lacheta L et al. (2020) Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up. Knee Surg Sports Traumatol Arthrosc 28:1230–1235PubMed
41.
Zurück zum Zitat Wilson TJ, Spinner RJ, Mohan R et al (2017) Sciatic nerve injury after proximal hamstring avulsion and repair. Orthop J Sports Med 5:2325967117713685PubMedPubMedCentral Wilson TJ, Spinner RJ, Mohan R et al (2017) Sciatic nerve injury after proximal hamstring avulsion and repair. Orthop J Sports Med 5:2325967117713685PubMedPubMedCentral
42.
Zurück zum Zitat Wood DG, Packham I, Trikha SP et al (2008) Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 90:2365–2374PubMed Wood DG, Packham I, Trikha SP et al (2008) Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 90:2365–2374PubMed
Metadaten
Titel
Klinische Ergebnisse nach Refixation proximaler Hamstring-Sehnen-Rupturen unter Berücksichtigung verschiedener Ankersysteme
verfasst von
M. Irger
P. Forkel
Prof. Dr. A. B. Imhoff
L. Willinger
Publikationsdatum
18.06.2021
Verlag
Springer Medizin
Erschienen in
Die Unfallchirurgie / Ausgabe 7/2021
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-021-01020-8

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