University of Oulu

Lempainen L, Kosola J, Pruna R, et al. Tears of biceps femoris, semimembranosus, and semitendinosus are not equal—a new individual muscle-tendon concept in athletes. Scandinavian Journal of Surgery. December 2021:483-491. doi:10.1177/1457496920984274

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal : a new individual muscle-tendon concept in athletes

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Author: Lempainen, Lasse1,2; Kosola, Jussi2,3; Pruna, Ricard4;
Organizations: 1Sports Trauma Research Unit, Hospital Mehiläinen NEO, Joukahaisenkatu 6, Turku, FI 20520, Finland
2Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
3Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
4FC Barcelona, Medical Services, FIFA Center of Excellence, Barcelona, Spain
5Department of Children and Adolescents, PEDEGO unit and MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
7Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy
8Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
9Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.9 MB)
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Language: English
Published: SAGE Publications, 2021
Publish Date: 2022-01-26


Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing.

Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced.

Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience.

Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.

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Series: Scandinavian journal of surgery
ISSN: 1457-4969
ISSN-E: 1799-7267
ISSN-L: 1457-4969
Volume: 110
Issue: 4
Pages: 483 - 491
DOI: 10.1177/1457496920984274
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Copyright information: © The Finnish Surgical Society 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 Lficense ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (