What are the implications of a biceps femoris muscle or tendon tear with retraction?

From the Guidelines

A bicep femoris muscle or tendon tear with retraction requires immediate medical attention and typically needs surgical intervention, especially when significant retraction is present. The management of such an injury should prioritize reducing pain and swelling, promoting healing, and restoring function to prevent long-term morbidity and impact on quality of life.

Initial Management

Rest, ice, compression, and elevation (RICE) should be implemented immediately after injury to manage pain and swelling, as suggested by general principles of soft tissue injury management 1. Relative rest, as opposed to complete immobilization, is recommended to decrease repetitive loading of the damaged tendon, allowing for the initiation of the healing process 1.

Rehabilitation

Physical therapy will be necessary for rehabilitation, beginning with gentle range of motion exercises and progressing to strengthening exercises over 3-6 months. This gradual progression is crucial for regaining strength and preventing further injury. The goal of rehabilitation is to restore full function, including strength and range of motion, to prevent chronic pain, weakness, and functional limitations.

Pain Management

Pain management may include NSAIDs like ibuprofen (400-600mg three times daily with food) for the first 1-2 weeks, as these can provide relief for acute pain, although their use should be judicious and based on individual patient needs and medical history.

Surgical Intervention

Surgery is often recommended for tears with significant retraction because the separated muscle or tendon ends cannot heal properly on their own, leading to poor outcomes in terms of strength and function if not addressed surgically. The bicep femoris is one of three hamstring muscles crucial for knee flexion and hip extension, making proper healing essential for normal function and preventing long-term disability.

Outcome and Return to Activity

Complete recovery typically takes 4-6 months, with return to sports activities only after regaining full strength and range of motion. It's essential to avoid premature return to activity to prevent re-injury and ensure complete healing. The natural history of tendon injuries suggests that most patients can recover within three to six months with appropriate treatment, including relative rest, icing, and eccentric strengthening exercises 1. However, the specific case of a bicep femoris muscle or tendon tear with retraction may require a more aggressive approach, including surgical intervention, to achieve optimal outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Bicep Femoris Muscle or Tendon Tear with Retraction

• A bicep femoris muscle or tendon tear with retraction is a serious injury that can affect athletes and individuals who engage in physical activities 2, 3, 4, 5.
• The injury can occur at the proximal musculotendinous junction of the biceps femoris long head, resulting in full thickness disruption of the tendon and muscle 2.
• Surgical repair is a common treatment option for this type of injury, and it has been shown to be effective in restoring function and reducing the risk of complications 2, 3, 4, 5.
• Studies have reported successful outcomes with surgical repair, including return to preinjury level of sporting activity, high patient satisfaction, and low risk of recurrence 2, 4.
• The use of suture anchor repair has been shown to be a reliable treatment option for acute avulsion injuries of the distal biceps femoris, allowing for early return to sport with restoration of hamstring strength 4.
• Delayed treatment can result in proximal retraction and atrophy of the muscle belly, requiring more complex surgery, highlighting the importance of prompt diagnosis and treatment 5.

Treatment Options

• Surgical repair is a recommended treatment option for bicep femoris muscle or tendon tears with retraction, particularly in individuals who require a high level of function 2, 3, 4, 5.
• Immediate surgical treatment is favored for both complete and partial injuries of the biceps femoris tendon, especially in athletes who require a high level of function 5.
• The use of instrumental examinations such as ultrasound and MRI can aid in clinical assessment and diagnosis of the injury 5.

Outcomes

• Studies have reported successful outcomes with surgical repair, including return to preinjury level of sporting activity, high patient satisfaction, and low risk of recurrence 2, 4.
• The mean time from surgical intervention to return to full sporting activity has been reported to be around 16.7 weeks, with all study patients returning to their preinjury level of sporting activity 4.