Tendon and muscle injuries

With increasing sporting activity in all age groups, soft-tissue injuries to the musculoskeletal system, especially tendon and muscle injuries, are increasingly moving into the focus of sports orthopedic surgeons. Anatomically, the muscles of the human body attach to the bones at each end via a tendon.

Injuries to this muscle-tendon complex often occur as a result of chronic excentric weightbearing or overload.

A distinction is made here between injuries to the muscles in the sense of small muscle fiber tears, the somewhat larger muscle bundle tears and complex muscle tears.

While muscle fiber tears and smaller muscle bundle tears can be treated conservatively, surgical reconstruction is recommended for extensive damage, especially for active patients with the desire to, participate in sports.

If a trauma (e.g. a fall) leads to an overload of a muscle group or a specific muscle, injuries usually occur in the tendinous area. Often the affected tendons are already damaged due to degeneration.

In the upper extremity (arm), the most common sports orthopaedic tendon injuries are damage to the tendons of the biceps muscle and the triceps muscle.

• Tears of the long head of biceps tendon at the shoulder are usually treated conservatively as there is only a marginal loss of strength. If a rupture of the short head of biceps tendon occurs, surgical refixation should be performed to restore the ability to flex at the elbow and externally rotatate (supinate) the forearm.
• Ruptured tendons of the lower part of the biceps muscle and lesions of the triceps muscle, are usually reattached to the bone operatively via suture anchors.

In order to avoid postoperative joint stiffness, physiotherapy is performed at an early stage.

In the the lower extremity (leg), injuries of the thigh muscles and damage to the Achilles tendon play an important role in sports orthopaedics.

• The hamstring muscles are typically overloaded with combined movements of hip flexion and knee extension when slipping on a smooth surface, often resulting in ruptures of the tendons at their pelvic attachments. This largely results in reduced strength when bending the knee joint and often causes pain when seated.
• Injuries to the quadriceps muscles of the thigh, often occuring during extension of the knee joint against resistance, can  present at the pelvic attachment or at the knee. Ruptures of the quadriceps tendon, the insertion of the quadriceps muscle at the kneecap, play an important role and lead to weakness or even a loss of the ability to stretch the knee joint.

In order to completely restore muscular function, anchor refixation or occasionally minimally invasive tendon suture techniques are employed.

• Injuries to the Achilles tendon, the connection between the calf muscles and the hindfoot, are usually caused by a traumatic event, often with a predisposition due to an existing degenerative process. After removal of the degenerative tissue, the surgical management consists of a suture reconstruction (when the lesion is far from the insertion point) or an anchor refixation at the bone (in an avulsion injury).

Conservative or surgical treatment is recommended on an individual basis depending on the patient age, the type and location of the rupture, level of sporting activity and the general state of health of the patient.