Rehabilitation Following a Distal Semitendinosus Excision in a Collegiate American Football Player: A Resident’s Case Report

Introduction: Hamstring injuries are a common time-loss injury in American football. Conservative management is often attempted but possesses high rates of reinjury. In the presence of distal semitendinosus tendon avulsions with retraction, excision procedures have shown increased return to sport success rates with less time loss compared to conservative management. The purpose of this case report is to describe the surgical management and postoperative rehabilitation program for a collegiate American football player after a distal semitendinosus excision procedure. # Case Description The subject was a 20-year-old male collegiate American football player who presented with a left distal semitendinosus tendon avulsion with retraction. Due to significant pain and limitations from the initial injury, attempts to conservatively rehab failed and the subject underwent a distal semitendinosus tendon excision procedure. Post-operative physical therapy interventions followed a multi-phase approach based on physiological tissue healing and patient response to exercise. Patient reported outcomes including the Functional Assessment Scale for Acute Hamstring Injuries (FASH), Single Assessment Numeric Evaluation (SANE), and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) were utilized along with isometric and eccentric dynamometry, force plate and Global Positioning System (GPS) analysis to determine readiness to return to sport. # Outcomes The subject completed 24 physical therapy sessions over the course of 12 weeks in addition to 36 treatment sessions with the athletic training staff and a weightroom exercise program. At return to sport, clinically meaningful improvement was observed in patient reported outcomes including FASH, SANE, and OSPRO-YF. Additionally, strength and functional task performance superseded pre-injury levels and thresholds of clinical significance. The subject returned to sport at 12 weeks post-operatively. Conclusion: The subject in this case effectively returned to participation in collegiate American football 12-weeks after distal semitendinosus tendon excision procedure and participation in a multi-phased rehabilitation program. The distal semitendinosus excision procedure and rehabilitation approach presented in this case report would benefit from continued research in other athletes. Level of Evidence: Level 5.