Ischial avulsion injuries are considered the most severe hamstring injury.
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Epidemiology
These are rare injuries and are more common in adolescents than in adults 2.
Pathology
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 is the conjoint tendon (of semitendinosus and biceps femoris) fully detaching with a partial or full-thickness injury of semimembranosus 1.
Treatment and prognosis
Both operative and non-operative treatments have been shown to have similar outcomes at 1 year 3.
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