Proximal avulsion of the hamstring in young athlete patients: a case series and review of literature

: Hamstring injuries are a frequent occurrence of athletes, leading to a stop in practice and long-term alterations in sports performance. About 12% of these lesions involve avulsion at the level of the proximal insertion that can be complete (about 6%) or partial. Starting from an epidemiological and treatment evaluation of these lesions in literature, the aim of this study was to examine the functional outcomes and the rate of "return to play" in a population composed of athletes of various levels who have undergone surgery to reinsert the hamstring muscles at the ischial insertion, for a complete detachment of one or more tendon heads. Therefore, a retrospective study was carried out where 18 patients treated at the Orthopedics and Traumatology Unit of the I.R.C.C.S. San Matteo in Pavia (Italy) were identified in a time span ranging from March 2012 to August 2020. The sample was analysed taking into account age, sex and risk factors, as well as the pathophysiology and anatomy of the injury using the Wood classification, the time elapsed before surgery, the duration of the rehabilitation protocol and the possible return to sports activity, comparing the level of sports performance in the pre- and post-operative period using the Tegner Activity Score (TAS). Different post-operative outcome evaluation scores (Perth Hamstring Assessment Tool PHAT and Lower Extremity Functional Scale LEFS) were also compared with each other in order to find a correlation with the real level of return to sporting activity. The mean age at surgery was 26.4 11.6 years. The population is composed of 14 males (77.8%) and 4 females (22.2%). All 18 patients returned to sports following surgery (100%). Of these patients, 17 (94%) maintained a level of sports performance equal to that before the injury. 100% of patients rated the outcome of the surgery as satisfactory. This study has shown that Hamstring reinsertion surgery is a correct indication in all athletes, allowing them a satisfactory return to sports practice.