Return to sport and beyond following intramuscular tendon hamstring injury: A case report of an English Premier League football player

BackgroundHamstring strain injuries are the most common type of injury in elite football and are associated with a high risk of reinjury, particularly those involving the intramuscular tendon (IMT). Limited information is available regarding the rehabilitation and return to sport (RTS) processes following such injuries. This case study describes the clinical presentation of an elite football player following IMT hamstring injury, their on- and off-pitch rehabilitation alongside performance monitoring throughout RTS and beyond.Case scenarioAn elite football player suffered a grade 2c hamstring injury during an English Premier League (EPL) match. The player underwent early post-injury management, alongside progressive off-pitch physical preparation. The ‘control-chaos continuum’ was used as a framework for on-pitch rehabilitation to prepare the player for a return to full team training and competition. Objective and subjective markers of the player's response to progressive on- and off-pitch loading were monitored throughout RTS and beyond.OutcomesThe player returned to on-pitch rehabilitation after 11 days, to full team training having achieved weekly pre-injury chronic running load outputs after 35 days and played in the EPL 40 days post-injury. The player did not suffer reinjury for the rest of the EPL season.ConclusionAn understanding the unique structural and mechanical properties of the IMT, alongside expected RTS timeframes are important to inform rehabilitation and decision-making processes post-injury. Performance and frequent load-response monitoring throughout RTS and beyond, in conjunction with practitioner experience and effective communication are critical in facilitating effective RTS and reduce risk of reinjury following IMT injury.     

Non‐Invasive Ultrasound Quantification of Scar Tissue Volume Identifies Early Functional Changes During Tendon Healing

Tendon injuries are very common and disrupt the transmission of forces from muscle to bone, leading to impaired function and quality of life. Successful restoration of tendon function after injury is a challenging clinical problem due to the pathological, scar‐mediated manner in which the tendons heal. Currently, there are no standard treatments to modulate scar tissue formation and improve tendon healing. A major limitation to the identification of therapeutic candidates has been the reliance on terminal endpoint metrics of healing in pre‐clinical studies, which require a large number of animals and result in destruction of the tissue. To address this limitation, we have identified quantification of scar tissue volume (STV) from ultrasound (US) imaging as a longitudinal, non‐invasive metric of tendon healing. STV was strongly correlated with established endpoint metrics of gliding function including gliding resistance and metatarsophalangeal (MTP) flexion angle. However, no associations were observed between STV and structural or material properties. To define the sensitivity of STV to identify differences between functionally discrete tendon healing phenotypes, we utilized S100a4 haploinsufficient mice (S100a4^GFP/+), which heal with improved gliding function relative to wild‐type (WT) littermates. A significant decrease in STV was observed in S100a4^GFP/+ repairs, relative to WT at day 14. Taken together, these data suggest US quantification of STV as a means to facilitate the rapid screening of biological and pharmacological interventions to improve tendon healing, and identify promising therapeutic targets, in an efficient, cost‐effective manner. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2476–2485, 2019     

跟腱断裂术后即刻功能锻炼的临床研究

目的:通过与跟腱断裂术后2周进行功能锻炼及下地部分负重行走的比较,探讨跟腱断裂术后即刻功能锻炼及下地部分负重行走对患肢功能及跟腱再断裂的影响。方法:将2012年3月至2013年3月收治的64例闭合性跟腱断裂手术患者分为两。治疗组34例,男18例,女16例;年龄(41.4±7.6)岁;于术后第2天即行功能锻炼及佩戴支具下地部分负重行走。对照组30例,男16例,女14例;年龄(39.9±7.6)岁;术后予患肢短腿石膏跖屈位固定2周,2周后行功能锻炼及佩戴支具下地部分负重行走。两组患者由同一组医生采用相同的手术方式处理,观察并比较两组患者AOFAS踝关节功能评分、跟腱再断裂及伤口并发症情况。结果 :术后2个月AOFAS评分治疗组74.3±3.9,对照组71.7±4.2,治疗组高于对照组;术后1年治疗组93.3±3.9,对照组92.0±4.1,两组比较差异无统计学意义。术后治疗组无跟腱再断裂,对照组1例发生跟腱再断裂;术后治疗组2例发生伤口并发症,对照组1例发生并发症,差异无统计学意义。结论:跟腱断裂术后患者即刻功能锻炼,踝关节AOFAS功能评分优于固定2周后再行功能锻炼,同时不增加术后跟腱再断裂率及并发症发生率,有利于患肢功能恢复。