2015 ISAKOS Biennial Congress ePoster #806
The Prevalence of Proximal Hamstring Pathology in the Asymptomatic Population
Simon M. Thompson, MBBS, BSc(Hon), MSc, MD(Res), FRCS(Tr&Orth), London UNITED KINGDOM
Sebastian Fung, MD, Sydney, NSW AUSTRALIA
David G. Wood, MBBS, FRACS, FA(Orth)A, Sydney, NSW AUSTRALIA
NSOSMC and Mater Imaging, Sydney, NSW, AUSTRALIA
FDA Status Not Applicable
Summary: Pathology of the proximal hamstring complex is more common than previously thought, there appears to be a high prevalence of pathology in the asymptomatic population at the time of MRI examination (22% have bilateral partial tears and 4% bilateral complete tears; the semi-membranosus is the most affected) which may help diagnosis and treatment.
Abstract:
Introduction
Injury to the proximal hamstring complex is becoming more frequently diagnosed. In patients requiring onward referral to a specialist in this field of orthopaedic surgery pre-existing pathology of the proximal hamstrings may have existed. The prevalence of pathology, however, has not been previously documented in the literature in asymptomatic subjects.
Method
253 consecutive patients who had pelvis and hip MRI examinations (1.5 Tesla magnet) and examination by a musculoskeletal clinical specialist at our institution were reviewed retrospectively between 2009 and 2010. All patients were asymptomatic from proximal hamstring pathology from the clinical history of the referring orthopaedic specialist.
The proximal hamstrings were evaluated in the axial and coronal planes for presence of normality, tendinopathy, partial and complete tears by a Consultant MSK Radiologist, and a fellowship trained orthopaedic surgeon trained in radiological reporting. Both right and left hamstring complexes (i.e. conjoined tendon of semi-tendinosus and biceps femoris; and the semi-membranosus) were reviewed in multiple planes.
Results
506 proximal hamstrings complexes were reviewed from 253 patients. 142 patients were female, 111 male. Age range was 13-89, average age 57. 59.
89 patients were radiological normal both sides (35.2%), average age 49 years (range 13-88).
34 patients (13.4%) had unilateral pathology, the average age in this group 61 years (range 33-87): 3 patients (1%) had presence of a complete tear, average age 78 years (range 72-87). 16 patients (7%) had tendinosis, average age 65 years (range 37-78). 15 patients (6%) had a unilateral partial tear, average age 53 years (range 35-78).
130 patients (52.5%) had bilateral pathology, average age 62 years (25-89 range): 53 patients (21%) had the presence of bilateral tendinopathy alone, average age 59 years (range 25-89). 66 patients (26%) had evidence of bilateral partial tears with or without tendinosis, average age 64 years (range 36-89).
Of this bilateral partial tear group it was apparent that 52.3% had tears of both conjoined tendon and semi-membranosus. The remaining 47.7% had a tear of either the conjoined or the semi-membranosus. The more commonly injured tendon was the semi-membranosus 73.8% of the time.
11 patients had bilateral complete ruptures (4%) with an average age of 69 (34-83).
Conclusion
Pathology of the proximal hamstring complex is more common than previously thought. There appears to be a high prevalence of pathology in the asymptomatic population at the time of MRI examination. 22% have bilateral partial tears and 4% bilateral complete tears. The semi-membranosus is the most affected, which may help diagnosis and treatment.