Surgical treatment of hamstring injuries and disorders – the clinical spectrum from chronic tendinopathy to complete rupture

Hamstring muscle injuries and tendon disorders are common, especially in sports. They can be severe and difficult to treat, often resulting in impaired athletic performance and long rehabilitation times. Previous studies considering treatment of these problems are scarce. The current study was designed to investigate the effect of surgery on different types of hamstring muscle injuries and on proximal hamstring tendinopathy. In addition, we wanted to study the typical histopathological findings relating to proximal hamstring tendinopathy. In the study of complete (all three muscles torn) proximal hamstring avulsions (41 patients), our results showed that early operative treatment gives significantly better results than late surgery, and is therefore recommended. Despite this, considerable improvement of symptoms could also be achieved in chronic cases. In the study of partial (one or two muscles torn) proximal hamstring tears (47 patients), we observed that these injuries can cause significant functional deficit and impaired performance in athletes. The main finding was that after surgical repair most of the patients were able to return to their pre-injury level of sports. In the study of distal hamstring tears (18 patients), the results showed that surgical treatment had a good effect in the majority of these cases. In proximal hamstring tendinopathy, the main problem is pain which limits sports. In this study (90 patients), we found that after unsuccessful conservative treatment, surgery was a good treatment option resulting in full return to sports in most cases. In tendinopathic hamstring tendons, the morphological changes of tendinosis were largely identical to those previously described in other common (e.g. Achilles and patellar) tendinopathies. In chronic proximal hamstring avulsions, and also in reoperations, a large defect between distally retracted tendons and the ischial tuberosity may occasionally prevent anatomic reinsertion. We have described a reconstruction method using fascia lata autograft augmentation to be used in these most challenging repairs. This technique was utilized in the treatment of five patients, with encouraging results.

Northern Landscapes : ʻʻImplementation of the European Landscape Convention In the North Calotte Area Municipalitiesʼʼ - Conference in Inari, Finland 7-9.9.2011

The conference promoting the objectives of the international European Landscape Convention (ELC) was held on 7-9 September 2011 in Inari. The primary aim of the conference was to increase awareness of the ELC and the prospects and requirements it brings to practical planning work, especially at the municipal level. The conference speakers included top experts from Sweden, Norway, Finland, France, Holland and Catalonia. This report is a collection of articles written by the experts in the ELC conference. The report is available in five languages: Finnish, Swedish, Norwegian, Northern Sámi and English. The common characteristics of the North Calotte area, such as the magnificent riverside scenery and the beautiful fell landscapes formed by the Sámi culture and reindeer management are broadly reflected in the environment. Alongside the traditional forms of land use, many other livelihoods and forms of land use now need to be accommodated in the area. Tourism, energy production, mining industry and new infrastructure create new and manifold challenges to the authorities in charge of land use in these areas. Municipalities need information and support for versatile planning in the future, so that the unique and valuable characteristics of the North can be preserved. Landscape protection and management in the landscape areas is executed through areal and land use planning, mainly through town planning and the creation of landscape management plans. The municipalities in the North Calotte region have their own partly divergent methods and practices, based on the various land use processes are executed. The municipalities and inhabitants have a great interest in preserving and protecting their living environment and maintaining and increasing the appeal of the area. Landscape is viewed as one of the most significant appealing factors that cannot be lost. The increasing land use in municipalities, for example due to energy production, mining industry and increasing tourism, create a need for more multidimensional planning. The reconciliation of the wishes of different interest groups, and traditional and new livelihoods will not be easy. Conflict is inevitable. This will lead to a greater need to engage local bodies to the planning processes right from the start of the projects. Close cooperation between different administrative branches, operators, local bodies and landscape research promote the objectives of the convention. To ensure that the work continues, a landscape co-operation group is planned to be established in the North Calotte area. It´s main task is to promote and develop landscape policy in the area.