Distal avulsion of reconstituted hamstring tendons

Purpose Hamstring tendon autograft (semitendinosus and gracilis) is the most commonly used graft in anterior cruciate ligament (ACL) reconstruction. Distal hamstring tendons avulsion is a rare condition, and this paper describes a previously unreported injury, local management of this rare injury pattern, and the existing literature regarding treatment options. Methods Two cases are presented of distal hamstring avulsion from the tibia of reconstituted tendons, together with additional 12 cases of distal hamstrings tendon avulsion. Functional outcomes following treatment of this injury are presented, together with a literature review of management options. Results Early surgical reattachment using suture anchor fixation was performed and excellent results were achieved in 93% of cases (13 out of 14 patients). Patient-reported outcome measures demonstrated a median Marx score 14.5 (IQR 4) and median SHORE score 34.5 (IQR 4). The mean time to surgery was 22 days (range 5–60), with mean time to return to sport at pre-injury level 5.5 months (range 2.5–12). Conclusions Distal hamstring tendon avulsion is a rare condition, with no consensus regarding optimal management options. Acute surgical repair leads to excellent results, with a return to pre-injury level of sporting activity. Level of evidence IV.