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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. 1Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  2. 2Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
  3. 3Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  4. 4Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5Department 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}amc.uva.nl, g.m.kerkhoffs{at}amc.nl

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Introduction

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) …

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