Damage to or Injury of the Distal Semitendinosus Tendon During Sporting Activities: A Systematic Review

  • Kathryn B. MetcalfEmail author
  • Derrick M. Knapik
  • James E. Voos
Review Article



Isolated distal semitendinosus tears and avulsions sustained during sporting activities are uncommon.


We sought to systematically review the literature to identify athletes sustaining distal semitendinosus tears and avulsions during sporting activities and to better understand injury mechanisms, management, and return-to-sport timing.


PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases were searched from January 1970 to January 2018 using the search terms distal hamstring, semitendinosus, sport, athlete, tear, rupture, and avulsion. Inclusion criteria were studies documenting (1) isolated, complete distal semitendinosus tears and avulsions during sporting activity, (2) injury management, and (3) athlete outcome. Exclusion criteria were studies reporting (1) partial tears, (2) injuries from non-sporting activities, or (3) athlete sustaining injury with concomitant injuries about the knee. Sporting activities, tear location, management strategy, time from injury to surgery, and return-to-sport timing were analyzed. Statistical analysis was used to evaluate return-to-sport timing based on treatment type and tear location.


Four studies met the inclusion criteria, comprising a total of 23 cases of complete, isolated distal semitendinosus avulsions or tears. Injuries were sustained predominantly while running or sprinting and most commonly were avulsions off the tibia. Injuries were treated surgically in 70% of cases. Overall time to return to sport was 2.5 ± 1.4 months with athletes treated conservatively returning significantly more quickly (1.5 ± 0.8 months) than athletes undergoing surgery (3.0 ± 1.3 months). Return-to-sport time was significantly shorter in athletes with complete avulsions (2.2 ± 1.3 months) than in those sustaining tears at the musculotendinous junction (3.8 ± 0.8 months). No significant correlation between time to surgery and return-to-sport time was appreciated.


Isolated, complete distal semitendinosus tears and avulsions remain infrequently reported during sporting activities and, in this review, occurred predominantly during non-contact activity. Athletes treated conservatively were found to return to sport more quickly, although additional studies are needed to determine the clinical relevance of treatment option, tear location, and concurrent injuries.


distal semitendinosus distal hamstring athlete tear avulsion 


Compliance with Ethical Standards

Conflict of Interest

Kathryn B. Metcalf, MD, and Derrick M. Knapik, MD, declare that they have no conflicts of interest. James E. Voos, MD, reports being a paid consultant to Arthrex, outside the submitted work.

Human/Animal Rights


Informed Consent


Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.


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Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  1. 1.Sports Medicine InstituteUniversity HospitalClevelandUSA
  2. 2.School of MedicineCase Western Reserve UniversityClevelandUSA
  3. 3.Department of Orthopaedic SurgeryClevelandUSA

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