Nearly half of distal semitendinosus ruptures fail with nonoperative treatment
Acute surgery recommend since half of these patients will 'wind up having surgery anyway.'
CALGARY, Alberta One of the first reported case series on distal semitendinosus ruptures found a 42% failure rate with conservative, nonoperative treatment.
Based on the results, the study authors recommend acute surgical resection in patients with painful masses and who have difficulty walking.
Daniel E. Cooper, MD, and colleague John E. Conway, MD, conducted a retrospective study of outcomes at 13 months follow-up among 17 professional athletes who received either nonoperative treatment or acute surgical resection for distal semitendinosus ruptures.
Cooper presented the results at the American Orthopaedic Society for Sports Medicine 2007 Annual Meeting, held here.
The investigators found that all five patients who received acute surgical resection recovered in an average of 6.8 weeks. However, only seven of the 12 conservatively treated patients recovered at an average of 10.4 weeks. The remaining five conservatively treated patients failed their nonoperative management and underwent acute surgical resection an average of 16.8 weeks after the initial injury. These five patients eventually recovered at an average of 12.8 weeks after receiving surgery, according to the study.
"In general, we recommend acute surgery since roughly half will wind up having surgery anyway," Cooper said in his presentation.
"Recovery seems quicker with acute surgery. We realize that in saying this that some did well without surgery, and if there's a painful mass in the popliteal area, and an inability to walk or extend their knee fully in a stance phase of gate, then we think that early surgery is an easier decision," he said.
The 17 patients included in the study were part of an original series of 25 patients treated over a 14-year period.
Cooper noted that patients presented with swelling, ecchymosis, knee flexion weakness and skin puckering during hamstring contraction. Magnetic resonance imaging of acute cases revealed edema, semitendinosus tendon retraction and minimized muscle volume. Also, some chronic cases showed a "ringing" effect, "similar to the rings of a tree on the axial images," he said.
For more information:
- Daniel E. Cooper, MD, can be reached at 9301 N. Central Expressway Ste. 400, Dallas, TX 75231; 214-220-2468.
- Cooper DF, Conway JE. Distal semitendinosus ruptures in elite athletes. Presented at the American Orthopaedic Society for Sports Medicine 2007 Annual Meeting. July 12-15, 2007. Calgary, Alberta, Canada.