Proximal hamstring avulsion

Case
A 26-year-old male professional football player presents after a ‘stretch’ type injury to his right hamstring. He experienced immediate pain and was unable to continue. Over the next 24 hours he developed extensive bruising over his posterior thigh. There was a palpable defect in the proximal tendon.

Findings
X-ray images of the hip and pelvis were normal. An MRI shows a complete tendon avulsion of the hamstring origin from the ischial tuberosity with approximately 10.5 cm of distal tendon retraction and moderate volume of interposed haematoma. No fracture or bony avulsion injury.

Discussion
Forty-eight hours after suffering this injury the player underwent surgical reattachment of the ruptured proximal hamstring. This was done without complication. After a progressive rehabilitation programme the player was able to return to play five months after the injury.

Unlike most other hamstring injuries avulsions of the proximal hamstring generally require surgical treatment. An avulsion of the proximal hamstring should be considered when a patient presents with significant bruising or swelling involving the posterior thigh after a hamstring injury. It may be possible to palpate a gap in the proximal tendon in these patients. The injury is generally best visualised on MRI while the outcome is generally considered to be enhanced when surgery can be performed shortly (within weeks) following the injury.

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