Ischial avulsion injuries are considered the most severe hamstring injury and often require surgical repair.
These are rare injuries and are more common in adolescents than in adults 2.
In adolescents, the injury involves avulsion of the apophysis causing a small fragment of bone to detach 2.
In adults, ischial avulsions are usually tendinous only with no bone involvement. The most common pattern being the conjoint tendon (of semitendinosus and biceps femoris) fully detaching with a partial or full-thickness injury of semimembranosus 1.
- 1. George Koulouris, David Connell. Hamstring Muscle Complex: An Imaging Review1. (2005) RadioGraphics. 25 (3): 571-86. doi:10.1148/rg.253045711 - Pubmed
- 2. Gidwani S, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents--an easily missed diagnosis. (2004) BMJ (Clinical research ed.). 329 (7457): 99-100. doi:10.1136/bmj.329.7457.99 - Pubmed