RESUMO
Hamstring injuries are common in athletes and can cause notable disability. They can be separated based on proximal, muscle belly, and distal injuries, with proximal and distal injuries more commonly requiring surgical intervention. Most injuries do not require acute MRI; however, MRI is useful in proximal and distal injuries as well as muscle belly tears that fail to respond to nonsurgical treatment. Acute repair of proximal avulsions, both partial and complete, result in successful outcomes, whereas chronic complete repairs are more difficult and less reliable. Muscle belly injuries have predictable outcomes but recurrence is common. Nonsurgical treatments focus on eccentric strengthening with the possible addition of low WBC platelet-rich plasma, which may have the potential to hasten recovery and decrease re-rupture. Distal injuries are relatively rare but may require surgical intervention. Hamstring reinjury is common, making continuation of preventive therapies after return to sport essential. Future research with larger sample sizes are required to determine how to decrease injury and reinjury rates, to evaluate the efficacy of platelet-rich plasma and to determine other treatments that may accelerate recovery after injury.
Assuntos
Traumatismos em Atletas/terapia , Músculos Isquiossurais/lesões , Traumatismos em Atletas/diagnóstico por imagem , Medicina Baseada em Evidências , Músculos Isquiossurais/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Recuperação de Função Fisiológica , Volta ao EsporteRESUMO
STUDY DESIGN: Biomechanical cadaver study. OBJECTIVE: To evaluate the relative effectiveness of Ponte osteotomies for spinal release in deformity correction. SUMMARY OF BACKGROUND DATA: Controversy exists as to the role of Ponte osteotomy in deformity correction surgery. Very little has been written about the biomechanical effects of Ponte osteotomy. Past biomechanical studies have been limited to application of forces through endplates, single functional units, or lack of comparison with anterior release. METHODS: Twelve fresh-frozen human full thoracic spinal units were tested for motion in axial rotation, flexion/extension, and lateral bending in a custom-designed robotic environment. Testing was repeated after sequential facetectomy and Ponte osteotomy (6 specimens) and compared with partial and full discectomy (6 specimens). RESULTS: Motion in axial rotation is increased 21% by Ponte osteotomy compared with 35% for full discectomy. Anterior displacement of the spinal column, creating lordosis, was increased 15% by Ponte osteotomy and 40% by full discectomy. Posterior displacement of the spinal column, creating kyphosis, was increased 23% by Ponte osteotomy and 89% by full discectomy. Finally, in coronal force application the Ponte osteotomy had virtually no effect (2%) compared with 40% increased motion by full discectomy. CONCLUSION: Posterior Ponte osteotomy releases produced more motion than facetectomy alone in axial rotation and sagittal correction maneuvers, but had no effect on coronal correction. Anterior discectomy release destabilized spinal column significantly more than posterior releases in all force applications. Despite ample clinical experience demonstrating the effectiveness of posterior-only surgery, the biomechanical effect of Ponte osteotomies is modest. LEVEL OF EVIDENCE: N/A.