Issue: February 2018
February 14, 2018
2 min read

Hamstring tendon pathology may increase with FAI

Patients with FAI in the study had a 41% prevalence of hamstring tendon pathology compared with age-matched controls.

Issue: February 2018
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Patients with femoroacetabular impingement may have an increased occurrence of hamstring tendon pathology, based on published results.

“All of the core muscles ... are interconnected, so that if one link has disfunction or stiffness this increases stress either upstream or downstream,” John D. Kelly IV, MD, director of shoulder sports medicine at the University of Pennsylvania, told Orthopedics Today. “What we found was [femoroacetabular impingement] FAI or stiffness of the hip impingement did manifest with an increased risk of proximal hamstring pathology, which is located close to the hip joint.”

John D. Kelly IV, MD
John D. Kelly IV

Kelly credits colleague Nakul Talathi, BS, for comparing 40 patients with FAI to 45 age-matched controls. Musculoskeletal radiologists evaluated the MRI and magnetic resonance arthrography images for any hamstring (HS) tendon pathology.

They found patients with FAI had a statistically significant increase in the occurrence of HS tendon pathology vs. controls. Researchers found the prevalence of HS tendon pathology was 41.18% and 7.78%, respectively, in patients with FAI and in the control group.

“You are basically saying to someone: If you have significant FAI, you have about almost a 50% chance of incurring a significant HS injury,” Kelly, who is an Orthopedics Today Editorial Board Member, said.

Researchers observed a significant increase in the risk of developing HS tendon pathology among patients with FAI, for which the odds ratio for HS tendon pathology was 8.30 in patients with confirmed FAI vs. controls.

According to Kelly, to provide appropriate treatment, surgeons may need to change how they approach patients who present with FAI.

“What we are seeing clinically is a lot of hamstring tendinosis, which we see in runners and people who are athletic, and we think that is due to just overuse, due to hip stiffness, and increased demand on the hamstring because of the hip stiffness and this ... says that you cannot look at one entity in a vacuum,” Kelly said. “If someone has one problem with the core, you have to look at the entire kinetic chain. What we can do as orthopedists is help with the impingement and lessen the risk of, not only hamstring problems, but also pubis problems ... .”

Kelly said these results may have a significant impact on occult hip pathology.

“I think [this research] is going to probably increase awareness of occult hip pathology and [surgeons] are going to look more at the hip when they have ... repeated hamstring injury,” he said.


Research should continue to categorize certain HS injuries to see if there is more proximal HS tendinosis overuse and to look at how the next link in the kinetic chain— the lumbosacral junction — is affected, Kelly noted. – by Casey Tingle

Disclosure: Kelly reports no relevant financial disclosures.