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Due to their frequency, muscle injuries are one of the main ongoing concerns for high-level sports clubs. Hamstring injuries are one of the most common types of injury that are seen in sports like soccer or basketball. The severity is often worse if it affects the tendinous structures, since this complicates the prognosis and prolongs recovery times.
Injuries to the central hamstring tendon are generally located some 10-20 centimeters from its superior origin and can often be difficult to diagnose, since it can appear that only the muscle fibers have been affected. As yet, there is still no clear criteria for treatment. Although these injuries may recover with conservative treatment (rest, ultrasounds, massage and stretching), recurrences are frequent and there are cases when surgery appears to be advisable.
Two years ago, the FC Barcelona medical team decided to operate on the athletes with this type of injury, “if it was chronic and recurrent or if it was acute but the rupture was complete and the tendon ends were separated,” explains Ricard Pruna, head of medical services at the club.
Recently — together with the Sports Trauma Research Unit of Mehiläinen Hospital, Finland — an article was published on the results of this initiative in the journal The Orthopedic Journal of Sports Medicine.
So far eight athletes with this type of injury have received surgery, five of whom were professional soccer players who were suffering relapses. “In the case of acute injury, the surgery consists of gathering the ends of the tendon in what is known as an anchor suture,” explains Pruna. “If it is chronic, it needs to be retightened using a pin fixed in the upper region.”
All of the injuries were diagnosed using magnetic resonance. “We must have a clinical reason to suspect the injury and then repeat the imaging test after a certain time, so that the accumulated blood allows us to clearly observe the injury,” he says.
The results so far have been very positive. After completing rehabilitation, which lasted between 2.5 and 4 months, no problems have arisen in the follow-up period.
At a global level, this type of injury recurs in approximately 30% of cases. However, in this study, although the cases were technically given the worst prognosis, “there have been no relapses, and all the players have returned to pre-injury levels,” says Pruna.
In any case, more data is still needed, over a longer term. “We need to see a greater number of cases and to extend the evolution time in order to reach clear conclusions,” says Pruna, who also notes that he is “hopeful, because we are getting very good results. We are on our way to seeing that there are very clear indications for using surgery.”
The Barça Innovation Hub team
An article published in The Orthopaedic Journal of Sports Medicine —in which members of the club’s medical services participated— now suggests to consider the detailed structure of the area affected, and treating the extracellular matrix as an essential player in the prognosis of the injury.