The clinical case of the neglected damage of the semitendinous, the semimembranous and the biceps femoris muscles in an adolescent judo athlete

BACKGROUND: Sports-related injuries in children and adolescents can have their specific features related to the epidemiology, the structure and the difficulties of diagnostics and treatment. The injuries of the flexor muscles of the shin in children during the sports activities are a rare type of damage, which may be a reason for late diagnosis. The choice of treatment tactics in such a situation may cause difficulties for the specialist. CLINICAL CASE DESCRIPTION: The authors have followed-up the adolescent aged 17 years who was a judoka with a 3-year-old injury sustained during sparring. With the patient positioned lying prone, an evaluation was done for the muscle stamina by holding the completely extended leg above the contact surface: on the left side — 2 minutes, on the right side — 18 seconds. The lower extremity functional scale (LEFS) score was 49 points, indicating significant limitations. The following surgical treatments were performed: myolysis, tenolysis of the flexor muscles of the shin, neurolysis of the sciatic nerve branches, plication of the semimembranous muscle tendon, myotenodesis of the semitendinous muscle. Three months after surgery, a repeated evaluation was done in order to evaluate the function of the lower limb using the LEFS scale, as well as for the muscle stamina by measuring the time of holding the completely extended leg above the contact surface (position — lying prone): 62 points and 1 minute 43 seconds, respectively. The optimal variant for the injury of the flexor muscles in the shin is the early diagnostics and surgical treatment, providing the restoration of the functions in the injured muscles. In cases of neglected injuries, the restoration is possible only by means of reconstructive surgery. In cases of the significant defect and in the absence of the need for restoring the high athletic performance, alternative surgical techniques can be used. CONCLUSION: In case of the neglected injury with significant retraction of one of the flexor muscles in the shin and relative preservation of the other (provided the patient does not plan to return to professional sports), myotenodesis may be considered an effective surgical treatment option.