Hamstring muscle strain is a common sports related injury. It has been reported in a variety of sports, following acceleration or deceleration while running or jumping. Injury may vary from simple muscle strains to partial or complete rupture of the hamstring origin. Avulsion fracture of the ischial tuberosity has also been described. Simple hamstring muscle strains are treated conservatively. Surgical exploration and repair is currently advocated for partial or complete rupture of the hamstring origin. A few case series exists in literature suggesting the benefits of early intervention.

We report a series of 8 athletes who presented between 2002 and 2006 with complete tear of their hamstring origin. Avulsion of the ischial tuberosity was excluded in these cases. After confirming the diagnosis, early surgical exploration and repair or reattachment was performed. The patients were braced for 8 weeks. This was followed by specialist physiotherapy and a supervised rehabilitation programme over 6 months. All patients were followed up to monitor return to normal activities and sports. The sciatic nerve was scarred to the avulsed tendon in three cases. Neurolysis led to a rapid relief of symptoms. Cases where the hamstring origin had retracted more than 3 cm required a figure 7 incision. There were no major complications including nerve palsies.

An excellent functional outcome was noted by 12 months in all 8 patients. 7 of them returned to their previous level within 6-9 months of injury. One person despite a very good recovery, opted out of sports. No other complications were seen as a result of the surgical procedure. In conclusion, a tear of the origin of hamstring muscles is a significant injury. Early surgical repair and physiotherapy is associated with a good outcome and enables an early return to high level sports.

Aim: The purpose of this study is to explore the experience of a consultant orthopaedic surgeon, and to quantitatively describe the learning curve for hip arthroscopy.

Introduction: Arthroscopic surgery in orthopaedics is a well established procedure for both diagnostic and therapeutic purposes. Unlike many other joint arthroscopies, hip arthroscopy has been delayed in its development. It was first pioneered by Burman in 1931, who under-took a study on cadavers, stating that ‘it is manifestly impossible to insert a needle between the head of the femur and the acetabulum’. Over several decades, this technique has developed considerably, but still remains a technically demanding and difficult procedure. The learning curve for hip arthroscopy has not previously been objectively quantified.

Method: We prospectively reviewed the first 100 hip arthroscopies performed in the supine position between 1999 and 2004. Surgery was performed by a single experienced hip and knee consultant orthopaedic surgeon (FH). We assessed the operative time (traction time), surgeon comfort, patient satisfaction at 6 months and operative complications. This was analysed for consecutive blocks of 10 cases. Results of the first 10 and the remaining 90 cases, subsequently the first 20 and remaining 80 cases, and finally the first 30 and remaining 70 cases were compared for a difference.

Results: The mean traction time was 55 minutes (range: 36–94 minutes). Mean surgeon comfort was 73% (range: 52–89%). 49% of patients reported an excellent outcome at 6 months follow – up. Only 8% of patients reported an unsatisfactory outcome. The main complications noted were chondral damage (6 cases) and perineal injuries (4 cases). There was a remarkable decrease in complications from the first 30 cases compared to the remaining 70 operations. 5 cases of chondral damage was noted in the first 30 cases, compared to 1 (1.4%) in the remaining 70 cases. The number of perineal injuries was noted to decrease from 3 cases in the first 30 operations to 1 (1.4%) in the subsequent 70 operations.

There is an overall decrease in operative time over the 100 cases, representing a gradual learning process throughout. However, the fall from an average time of 75 minutes for the first 30 cases, to the average operative time of 30 minutes for the remaining 70 cases, is a significant learning process (40% fall in operative time). We thus, believe the learning curve to be 30 operations.

Conclusion: We have demonstrated that there is a considerable fall in operative time when comparing the first 30 cases with the remaining 70 cases. This quantitative decrease is indicative of a rapid learning curve. This is further suggested by the remarkable fall in complications during this learning phase.

Due to economic constraints, it has been suggested that joint replacement patients can be followed up in primary care. There are clinical, ethical and academic reasons why we must ensure that our joint replacements are appropriately clinically and radiologically followed up to minimise complications. This Editorial discusses this.

Bleeding is a major complication of revision total hip replacement. We report a case where the inflated balloon of a urinary catheter was used to temporarily control intrapelvic bleeding from the superior gluteal artery, while definitive measures for endovascular embolisation were made.