Surgical treatment of chronic post-traumatic hamstring origin pain with tendon transfer from the unfused ischial tuberosity apophysis to the native ischial bone

A case report of a 35-year-old female patient suffering from chronic hamstring origin pain after an acute strain injury is presented. The initial clinical examination demonstrated a significant tenderness of the left buttocks. The diagnostics showed a chronic displaced osteochondral fragment in the region of ischial tuberosity. The displaced fragment was interpreted as either an unfused apophysis or an unhealed childhood apophyseal avulsion fracture. The injury uncovered a “weak link” in the kinematic chain of posterior thigh and was therefore treated as a strain injury of pseudoarthrosis between the fragment and the pelvis. Conservative treatment, including physiotherapy and nonsteroidal anti-inflammatory medication, followed by a CT guided pain injection containing a corticosteroid and local anaesthetic failed to provide sufficient results. Therefore, operative treatment was recommended. Release and reattachment of the hamstring tendons from the fragment to the native os ischium, using three suture anchors, was performed with excellent results 15 months postoperatively. During the postoperative period and physical rehabilitation therapy, the patient gradually improved mobility, muscle strength and corrected her gait pattern. The patient was extremely satisfied with the surgical outcome and reported no discomfort or pain while performing daily activities.