Distal Semimembranosus Tendon Avulsions: Acute Surgical Repair in a Professional Rugby Player

The hamstring muscles and tendons are the most commonly injured muscle group in athletes. The hamstring tendons are particularly vulnerable to injuries, as they cross 2 joints and have a high proportion of type 2 muscle fibers. They act mainly as decelerators of the leg, and as they work eccentrically, they are prone to excessive force in the muscle-tendon unit. Most hamstring injuries are strains occurring at the myotendinous junction. Injuries may involve proximal bone-tendon ruptures and, more rarely, distal bone-tendon avulsions. Distal avulsion injuries most frequently involve the biceps femoris and semitendinosus, with semimembranosus tendon injuries being very uncommon. Injuries at the myotendinous junction have been shown to have good outcomes with nonoperative treatment. The rate of hamstring reinjuries after conservative treatment, however, can be relatively high. Proximal tendon avulsion injuries have better outcomes with surgical interventions. The literature regarding distal tendon injuries is limited, but poor outcomes have been reported with conservative management and delayed surgery. The few reports on the surgical treatment of distal tears of the hamstring muscle consist mainly of biceps femoris tears. Reports of injuries to the distal semimembranosus tendon are even more scarce. The purpose of this study was to report the results of the successful acute surgical repair of a distal semimembranosus tendon avulsion in a professional rugby player with 18 months’ clinical follow-up. Institutional review board approval was obtained for this study.