Hamstring and Quadriceps Injuries in Athletes (eBook)

Christopher C. Kaeding, MD, Judson Wilson Professor of Orthopedics, Director of Sports Medicine, Wexner Medical Center, The Ohio State University, Departments of Orthopedics and Sports Medicine, Columbus, OH, USA.James R. Borchers, MD, MPH, Associate Clinical Professor, Wexner Medical Center, The Ohio State University, Departments of Family Medicine and Sports Medicine, Columbus, OH, USA.

Preface 8
Abbreviations 14
Contents 10
Contributors 12
1: Functional Anatomy of the Hamstrings and Quadriceps 16
Introduction 16
Hamstrings 16
Normal Anatomy 16
Biceps Femoris 16
Semitendinosus Muscle 18
Semimembranosus Muscle 19
Muscle Composition 20
Variant Anatomy 20
Biomechanics 20
Quadriceps 21
Normal Anatomy 21
Rectus Femoris 22
Vastus Medialis 22
Vastus Lateralis 22
Vastus Intermedius 23
Quadriceps Tendon 23
Patella 24
Patellar Tendon and Retinaculum 24
Biomechanics 24
Imaging 25
Summary 27
References 27
2: Quadriceps and Hamstrings Strength in Athletes 30
Introduction 30
Assessment of Quadriceps and Hamstrings Strength in Athletes 30
Normative Data 32
Isokinetic Strength and Function in NCAA Division I Football Athletes 35
Quadriceps and Hamstrings Strength vs. Functional Movement ScreenTM 35
Quadriceps and Hamstrings Strength vs. Clinical Hop Tests 35
Quadriceps and Hamstrings Strength vs. Hip Abduction Strength 38
Limb (A)symmetry 39
Deficiencies in Quadriceps and Hamstrings Strength as a Risk for Injury 40
Hamstrings Strain-Type Injuries 41
Anterior Cruciate Ligament (ACL) Injuries 41
Summary 42
References 42
3: Epidemiology of Hamstring and Quadriceps Injury 44
Hamstring Injury 44
Quadriceps Injury 51
References 56
4: Midsubstance Hamstring Injuries in the Athlete 59
Hamstring Anatomy 59
Demographics and Risk Factors 60
Mechanism of Injury and Grading Scale 61
Clinical Presentation and Imaging 62
Treatment 62
Prevention and Recurrence 64
References 67
5: Acute Proximal Hamstring Tendon Avulsions 69
Introduction 69
Mechanism of Injury 69
Risk Factors for Proximal Hamstring Injury 69
Clinical Presentation 70
Differential Diagnosis 70
On-the-Field Evaluation 70
Physical Examination 71
Imaging 72
Radiographs 72
MRI 72
Ultrasonography 73
Classification 74
Ischial Tuberosity Avulsion Fracture 75
Management of Proximal Hamstring Avulsions 76
Nonoperative Management 76
Operative Management 76
Surgical Indications 76
Timing of Repair 77
Surgical Technique Options 77
Endoscopic Repair 77
Preoperative Planning and Positioning for Open Repair 77
Surgical Anatomy and Open Surgical Approach 78
Fixation 79
Risks and Complications 80
Postoperative Rehabilitation 80
Return to Sport 81
Postoperative Treatment Outcomes 81
Future Directions 81
Tissue Engineering 81
Platelet-Rich Plasma 82
References 82
6: Biologic Enhancement of Healing in Ham Injuries 85
Introduction 85
Platelet-Rich Plasma 86
Background 86
Current Clinical Applications 87
Effects of PRP on Muscle Tissue 88
Results of PRP for Hamstring Injury 89
Author’s Preferred Technique for PRP Administration 89
Growth Factors and Stem Cell Therapy 90
Summary 90
References 91
7: Hamstring Harvest: Rehabilitation and Clinical Outcomes 93
Introduction 93
Risk of Subsequent Hamstring Injury 93
Effects on Hamstring Strength 94
Does Preservation of the Gracilis Matter? 96
Is There an Advantage of Contralateral Harvest? 97
Do Hamstrings Regenerate After Harvest? 97
Summary 99
References 99
8: Proximal Quadriceps Injuries in Athletes 101
Anatomy 101
Quadriceps Strains 102
Quadriceps Contusions 105
Myositis Ossificans 106
Compartment Syndrome 107
Summary 107
References 107
9: Contusions, Myositis Ossificans, and Compartment Syndrome of the Thigh 109
Contusions 109
Imaging 110
Treatment 111
Complications 111
Compartment Syndrome 113
Summary 115
References 115
10: Quadriceps Tendon Ruptures 117
Introduction 117
Anatomy 117
Biomechanics 118
Etiology and Mechanism of Injury 119
Clinical Presentation 120
Imaging 120
Treatment 122
Partial 122
Complete 122
Chronic 126
Rehabilitation 128
Outcomes 128
Complications 131
Summary 131
References 132
11: Rehabilitation of Quadriceps Injuries 134
Rehabilitation of Muscle Injuries 134
Acute Stages: 0–5 Days 134
Repair Phase: 5–7 Days to 6 Weeks 134
Remodeling Phase: 7 Weeks to 3 Months 139
Functional Return to Sport 139
Rehabilitation Following Extensor Mechanism Disruption 141
Phase I 142
Phase II: 6–12 Weeks 142
Phase III: 12–24 Weeks 143
Functional Return to Sport 143
Summary 143
References 143
12: Hamstring Injury Rehabilitation and Injury Prevention 146
Introduction/Etiology 146
Risk Factors 146
Previous Injury 146
Hamstring Strength Asymmetry Between Lower Extremities 147
Hamstring:Quadriceps Strength Ratio 147
Decreased Gluteal and Core Musculature Strength 147
Non-operative Rehabilitation 148
Phase I 148
Acute Phase 148
Phase II 149
Phase III 150
Postoperative Rehabilitation 151
Immediate Postoperative Period 151
Week 1 151
Weeks 2–3 151
Weeks 4–6 152
Week 7+ 152
Return-to-Sport Criteria and Testing 153
Injury Prevention 155
Summary 157
References 157
Index 160