Hamstring tendon injury

The research in this thesis focuses on relevant aspects of free and intramuscular hamstring tendon injury for daily clinical practice: anatomy, diagnosis, treatment decision-making, and outcomes.
Chapter 2 describes anatomy of the hamstring muscle complex with emphasis on the proximal attachment.
Chapter 3 is a call for awareness as we suspect that proximal free tendon injuries are frequently missed. It describes pearls and pitfalls for recognition.
Chapter 4 summarises the available literature in a systematic review of outcome following operative treatment of proximal hamstring avulsions.
Chapter 5, an expert opinion survey, provides an overview of clinical practice and generated further research hypotheses, identifying evidence gaps.
Chapter 6 reports intra- and inter-rater reliability of hand-held isometric hamstring strength tests in high-level rugby players. These are used in clinical and research settings and their reliability is subject to debate, especially in very strong athletes.
Chapter 7 describes inter-rater reliability for the main imaging parameters used in treatment decision-making and introduces a novel radiological sign to identify proximal tendons with full-thickness injury.
In Chapter 8, short- to medium-term outcomes of operative and non-operative treatment are reported in a prospective cohort study on proximal hamstring tendon avulsions using a shared decision-making model.
Chapter 9 evaluated the association between intramuscular tendon injury and time to RTP, followed by association with re-injury rate in Chapter 10.
In Chapter 11, the most important findings are discussed, along with implications and recommendations for clinical practice and future research.
Chapter 12 summarises this thesis followed by a Dutch summary.