Skip to main content

Advertisement

SpringerLink
Log in

Gross anatomical and dimensional characteristics of the proximal hamstring origin

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The current study was undertaken to better define the gross anatomical and dimensional characteristics of the proximal hamstring origin.

Methods

Twelve paired whole-lower extremities from six embalmed cadavers were dissected. The gross anatomy of the proximal hamstrings was studied. With the tendons attached to the ischial tuberosity, the width and thickness of each tendon was measured 1 cm distally to their origin, and the distance from the most proximal border of the common origin of the semitendinosus (ST) and long head of the biceps (LB) to their distal junction was assessed. After removal of the hamstring group, the shape, orientation, and dimension of the tendon footprints were determined.

Results

One cadaver demonstrated unique anatomy, which was considered as an anatomic variant and was therefore excluded from the study group. The ST and LB had a common origin on the posterolateral aspect of the ischial tuberosity (ST/LB), whereas the semimembranosus (SM) had a separated origin at the anterolateral aspect. The mean distance from the most proximal border of the ST/LB origin to the distal junction was 10.0 ± 1.3 cm. The shape of both footprints was longitudinal-oval, with the longitudinal axes of the SM and ST/LB footprints parallel aligned. Mean tendon width was 3.4 ± 0.5 cm for the common ST/LB complex and 4.2 ± 0.9 cm for the SM (p = 0.009). The corresponding values for tendon thickness were 1.0 ± 0.3 cm (ST/LB) and 0.8 ± 0.2 cm (SM), respectively (n.s.). Mean footprint length was 3.9 ± 0.4 cm for ST/LB and 4.5 ± 0.5 cm for SM (p = 0.002). The corresponding values for footprint height were 1.4 ± 0.5 cm (ST/LB) and 1.2 ± 0.3 cm (SM), respectively (n.s.).

Conclusion

The ST and LB had a common origin, whereas the SM originated separately. The site of origin of both tendons was the lateral aspect of the ischial tuberosity, with the SM footprint lying directly anterior to the footprint of the ST/LB complex. The footprint of the SM was significantly wider than the footprint of the ST/LB. The reported gross anatomic findings and dimensions may aid surgeons in anchor placement at the anatomical attachment site, thereby facilitating anatomic hamstring repair. In addition, the provided data may improve diagnosis and conservative treatment of proximal hamstring tendinopathy, since detailed knowledge about the normal anatomy is crucial for recognizing tendon abnormalities and for several conservative treatment modalities such as shockwave application or ultrasound-guided injections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ahmad CS, Redler LH, Ciccotti MG, Maffulli N, Longo UG, Bradley J (2013) Evaluation and management of hamstring injuries. Am J Sports Med 41(12):2933–2947

    Article  PubMed  Google Scholar 

  2. Aldridge SE, Heilpern GN, Carmichael JR, Sprowson AP, Wood DG (2012) Incomplete avulsion of the proximal insertion of the hamstring: outcome two years following surgical repair. J Bone Joint Surg Br 94(5):660–662

    Article  CAS  PubMed  Google Scholar 

  3. Barnett AJ, Negus JJ, Barton T, Wood DG (2014) Reattachment of the proximal hamstring origin: outcome in patients with partial and complete tears. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2817-0

  4. Battermann N, Appell HJ, Dargel J, Koebke J (2011) An anatomical study of the proximal hamstring muscle complex to elucidate muscle strains in this region. Int J Sports Med 32(3):211–215

    Article  CAS  PubMed  Google Scholar 

  5. Beltran L, Ghazikhanian V, Padron M, Beltran J (2012) The proximal hamstring muscle-tendon-bone unit: a review of the normal anatomy, biomechanics, and pathophysiology. Eur J Radiol 81(12):3772–3779

    Article  PubMed  Google Scholar 

  6. Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg Am 93(19):1819–1826

    Article  PubMed  Google Scholar 

  7. Bowman KF Jr, Cohen SB, Bradley JP (2013) Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 41(6):1363–1371

    Article  PubMed  Google Scholar 

  8. Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13(5):411–418

    Article  PubMed  Google Scholar 

  9. Cattrysse E, Barbaix E, Janssens V, Alewaeters K, Van Roy P, Clarijs JP (2002) Observation of a supernumerary hamstring muscle: a state of the art on its incidence and clinical relevance. Morphologie 86(274):17–21

    CAS  PubMed  Google Scholar 

  10. Chahal J, Bush-Joseph CA, Chow A, Zelazny A, Mather RC 3rd, Lin EC, Gupta D, Verma NN (2012) Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal? Am J Sports Med 40(10):2325–2330

    Article  PubMed  Google Scholar 

  11. Clanton TO, Coupe KJ (1998) Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 6(4):237–248

    CAS  PubMed  Google Scholar 

  12. Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15(6):350–355

    PubMed  Google Scholar 

  13. Cohen SB, Rangavajjula A, Vyas D, Bradley JP (2012) Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 40(9):2092–2098

    Article  PubMed  Google Scholar 

  14. Cross MJ, Vandersluis R, Wood D, Banff M (1998) Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med 26(6):785–788

    CAS  PubMed  Google Scholar 

  15. De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 174(2):393–399

    Article  PubMed  Google Scholar 

  16. Dierckman BD, Guanche CA (2012) Endoscopic proximal hamstring repair and ischial bursectomy. Arthrosc Tech 1(2):e201–e207

    Article  PubMed Central  PubMed  Google Scholar 

  17. Domb BG, Linder D, Sharp KG, Sadik A, Gerhardt MB (2013) Endoscopic repair of proximal hamstring avulsion. Arthrosc Tech 2(1):e35–e39

    Article  PubMed Central  PubMed  Google Scholar 

  18. Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36(1):104–109

    Article  PubMed  Google Scholar 

  19. Garrett WE Jr, Rich FR, Nikolaou PK, Vogler JB 3rd (1989) Computed tomography of hamstring muscle strains. Med Sci Sports Exerc 21(5):506–514

    Article  PubMed  Google Scholar 

  20. Harris JD, Griesser MJ, Best TM, Ellis TJ (2011) Treatment of proximal hamstring ruptures-a systematic review. Int J Sports Med 32(7):490–495

    Article  CAS  PubMed  Google Scholar 

  21. Konan S, Haddad F (2010) Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. Int Orthop 34(1):119–123

    Article  PubMed Central  PubMed  Google Scholar 

  22. Koulouris G, Connell D (2005) Hamstring muscle complex: an imaging review. Radiographics 25(3):571–586

    Article  PubMed  Google Scholar 

  23. Lefevre N, Bohu Y, Naouri JF, Klouche S, Herman S (2013) Returning to sports after surgical repair of acute proximal hamstring ruptures. Knee Surg Sports Traumatol Arthrosc 21(3):534–539

    Article  CAS  PubMed  Google Scholar 

  24. Lempainen L, Banke IJ, Johansson K, Brucker PU, Sarimo J, Orava S, Imhoff AB (2014) Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2912-x

  25. Lempainen L, Sarimo J, Heikkila J, Mattila K, Orava S (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40(8):688–691

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Lempainen L, Sarimo J, Orava S (2007) Recurrent and chronic complete ruptures of the proximal origin of the hamstring muscles repaired with fascia lata autograft augmentation. Arthroscopy 23(4):e441–e445

    Article  Google Scholar 

  27. Lindner D, Trenga AP, Stake CE, Jackson TJ, El Bitar YF, Domb BG (2014) Endoscopic repair of a chronic incomplete proximal hamstring avulsion in a cheerleader. Clin J Sport Med 24(1):83–86

    Article  PubMed  Google Scholar 

  28. Miller SL, Gill J, Webb GR (2007) The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am 89(1):44–48

    Article  PubMed  Google Scholar 

  29. Peterson JE, Currarino G (1981) Unilateral absence of thigh muscles confirmed by CT scan. Pediatr Radiol 11(3):157–159

    Article  CAS  PubMed  Google Scholar 

  30. Pombo M, Bradley JP (2009) Proximal hamstring avulsion injuries: a technique note on surgical repairs. Sports Health 1(3):261–264

    Article  PubMed Central  PubMed  Google Scholar 

  31. Sallay PI, Friedman RL, Coogan PG, Garrett WE (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24(2):130–136

    Article  CAS  PubMed  Google Scholar 

  32. Sarimo J, Lempainen L, Mattila K, Orava S (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36(6):1110–1115

    Article  PubMed  Google Scholar 

  33. Sato K, Nimura A, Yamaguchi K, Akita K (2012) Anatomical study of the proximal origin of hamstring muscles. J Orthop Sci 17(5):614–618

    Article  PubMed  Google Scholar 

  34. Skaara HE, Moksnes H, Frihagen F, Stuge B (2013) Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 41(11):2577–2584

    Article  PubMed  Google Scholar 

  35. Stoane JM, Gordon DH (1995) MRI of an accessory semimembranosus muscle. J Comput Assist Tomogr 19(1):161–162

    Article  CAS  PubMed  Google Scholar 

  36. van der Made AD, Wieldraaijer T, Kerkhoffs GM, Kleipool RP, Engebretsen L, van Dijk CN, Golano P (2013) The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2744-0

  37. Woodley SJ, Mercer SR (2005) Hamstring muscles: architecture and innervation. Cells Tissues Organs 179(3):125–141

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department for Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Matthias J. Feucht, Johannes E. Plath, Gernot Seppel, Stefan Hinterwimmer, Andreas B. Imhoff & Peter U. Brucker

  2. Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany

    Matthias J. Feucht

  3. Sportsclinic Germany, 81737, Munich, Germany

    Stefan Hinterwimmer

Authors
  1. Matthias J. Feucht
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes E. Plath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gernot Seppel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Hinterwimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas B. Imhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter U. Brucker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas B. Imhoff.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feucht, M.J., Plath, J.E., Seppel, G. et al. Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 23, 2576–2582 (2015). https://doi.org/10.1007/s00167-014-3124-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3124-0

Keywords

Search

Navigation