From injury to sport: a rehabilitation program after hamstrings tendon surgery repair in a professional rugby player: a case report
Autori
De Marco Gianluca (Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy)
Giordano Arena (private practitioner)
Michele Margelli (Department of Human Neuroscience, University of Rome“Sapienza” , Rome, Italy)
Introduction to clinical case
Currently, there is no established consensus or guideline on the most appropriate rehabilitation program following surgical reconstruction of the biceps femoris tendon in professional athletes. Consequently, rehabilitation interventions, outcome measures, and timelines remain unclear, therefore, the aim of this case report is to provide an accurate description of the programme and timeline about rehabilitation in a 25 year old elite rugby player who underwent surgery following distal lesion of biceps femoris tendon.
Methods
This case report was conducted in accordance with the CARE guidelines to ensure transparency and completeness in reporting. The rehabilitation process, including clinical reasoning, intervention strategies, outcomes and timeline was documented in detail throughout the patient’s recovery and return to sport.
Results
Rehabilitation was divided into phases according to the objectives identified with the patient using specific outcome measures: the first rehabilitation phase (protection and healing; 1-8 week) aimed to maintain gait pattern, knee’s rom, except full extension, activation of the legs muscles (isometric contraction). After that the second phase (function; 9-12 week) goal to achieve the full function of the knee and the leg through a full recovery of the knee’s rom, comparable strength between the principal leg muscles, a normal gait, introduces run and jump exercises.
In the third phase (performance; 13-16 week) all the functions were empower, like increasing the strength of both legs by 10%, increasing running distance and speed (4-5 Km, speed >20km/h) and enhancing some cognitive tasks in a movement tailored contest. Finally the last phase (return to sport and play; week 17-24) focuses on controlled sport-specific skill movement and chaos sport-specific skills, achievement of 60′ continuous running and high speed running exercises ( > 25 km/h), and perform sport contest task like contact, suddenly change of directions, receiving and managing ball. At the end of the rehabilitation the athlete achieved a complete recovery of strength, running ability and excellent performance in all the outcome measures used.
Discussion and clinical relevance
In absence of clear guidelines for the rehabilitation after surgical reconstruction of the biceps femoris tendon, this case report aimed to provide a useful timetable, program and outcome measures from disability to return to sport in professional athletes. Further studies, including randomized controlled trials, are needed to provide clinicians with a clearer understanding of effective treatment methods for this type of myotendinous injury.
REFERENCES
Azzopardi C, Beale D, James SL, Botchu R. Isolated Complete Distal Biceps Femoris Tendon Tears: Case Series and Literature Review. Indian J Radiol Imaging. 2022 Jan 10;31(4):998-1001. doi: 10.1055/s-0041-1741106. PMID: 35136515; PMCID: PMC8817825.
Lempainen L, Sarimo J, Mattila K, Heikkilä J, Orava S, Puddu G. Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment. Br J Sports Med. 2007 Feb;41(2):80-3; discussion 83. doi: 10.1136/bjsm.2006.031211. Epub 2006 Nov 30. PMID: 17138628; PMCID: PMC2658938.
Kusma M, Seil R, Kohn D. Isolated avulsion of the biceps femoris insertion-injury patterns and treatment options: a case report and literature review. Arch Orthop Trauma Surg. 2007 Nov;127(9):777-80. doi: 10.1007/s00402-006-0216-4. Epub 2006 Sep 14. PMID: 16972058.
Marín Fermín T, Aminake G, Vasiliadis AV, Kalifis G, Grabowski R, Macchiarola L, Al-Dolaymi AA. Surgical treatment of distal hamstring tendon injuries yield a higher return-to-sports rate: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):763-776. doi: 10.1002/ksa.12075. Epub 2024 Feb 12. PMID: 38344882.
Houdane A, Othman RK, Javaid HA, Taha AM, Ahmmed IM, Maklad AE. Traumatic Isolated Avulsion Rupture of the Distal Semitendinosus Tendon in a Non-athlete. Cureus. 2023 Sep 12;15(9):e45141. doi: 10.7759/cureus.45141. PMID: 37842392; PMCID: PMC10570402.
