Article Text

Download PDFPDF
Potential hamstring injury blind spot: we need to raise awareness of proximal hamstring tendon avulsion injuries
  1. Anne D van der Made1,2,3,
  2. Johannes L Tol2,3,4,
  3. Gustaaf Reurink1,2,3,
  4. Rolf W Peters2,5,
  5. Gino M Kerkhoffs1,2,3
  1. 1 Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  2. 2 Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
  3. 3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  4. 4 Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5 Department of Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Anne D van der Made, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam 1100 DD, The Netherlands; a.d.vandermade{at}, g.m.kerkhoffs{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


A recent thought-provoking editorial1 suggested that the reported annual increase in hamstring injuries could in fact be associated with increased awareness rather than an actual increase in injury incidence. We share the author’s optimism on the improving knowledge on (musculotendinous) hamstring injuries, yet we still have concerns regarding awareness of its evil twin—the full-thickness hamstring tendon avulsion.

In this letter, we argue that there is a ‘blind spot’ when it comes to diagnosing these serious injuries.

Are clinicians more at risk or more vigilant?

Hamstring tendon avulsions mostly affect the proximal tendons, and are typically sustained during sports or slip and fall accidents involving a combination of forceful hip flexion and knee extension.2 Our ongoing prospective study raised concerns that medical professionals may be disproportionally affected by these injuries. We noticed that 20% (95% CI 9% to 37%) of included patients with a full-thickness proximal hamstring tendon avulsion were medical doctors and physiotherapists. In the Netherlands, medical doctors and physiotherapists make up approximately 0.8% of the adult population.3 4 This percentage is in sharp contrast with the significantly higher proportion of those medical professionals that we encountered in our cohort of patients with a full-thickness proximal hamstring tendon avulsion.

Interestingly, we observed that substantial diagnostic delay (ie, time between injury and MRI-confirmed diagnosis) …

View Full Text


  • Contributors ADvdM, JLT and GR: writing and editing of the manuscript. RWP and GMK: writing and conceptual outline of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.