Ischial avulsion injury
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Ischial avulsion injuries are considered the most severe hamstring injury.
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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 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.
- 1. Koulouris G & Connell D. Hamstring Muscle Complex: An Imaging Review. Radiographics. 2005;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. BMJ. 2004;329(7457):99-100. doi:10.1136/bmj.329.7457.99 - Pubmed
- 3. van der Made A, Peters R, Verheul C et al. Proximal Hamstring Tendon Avulsions: Comparable Clinical Outcomes of Operative and Non-Operative Treatment at 1-Year Follow-Up Using a Shared Decision-Making Model. Br J Sports Med. 2022;:bjsports-2021-104588. doi:10.1136/bjsports-2021-104588 - Pubmed