0:00

So the last case, uh, uh, really, uh,

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interesting case an an anatomically

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and, uh, I learned quite a bit, uh, along with, uh,

0:10

my fellows who taught me about this anatomy.

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Uh, and thank you Dr. Chang.

0:15

Uh, um, so we, uh, I like this case.

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Um, this is a, uh, an adult with chronic posterior hip pain

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and going right into the salient findings.

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We can see right off the bat at the, in the area

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of the conjoin tendon,

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but we'll call this the biceps femoris and, uh,

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and semi tendinosis, uh, origins.

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We see that there are a couple of, uh, OCI bodies, uh,

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sub centimeter to per centimeter at the origin

0:45

of the hamstring complex.

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So the hamstring complex, a lot of, uh, great anatomy

0:51

and complex anatomy here, right?

0:53

So the, we know that the, uh,

0:55

semi menos arises from the, uh,

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lateral facet whilst the conjoint tendons,

1:01

or that is the biceps femoris

1:03

and semi tendinosis arise from the more

1:06

medial facet right here.

1:08

Okay? Uh,

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the neat thing about this case is even though this, uh,

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these, uh, obstacles indicate chronic injury,

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there's not a lot of edema,

1:18

as we can see from our fluid sensitive sequences.

1:21

This, uh, acles

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and these tendons have not really distally retracted,

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and we were sort of scratching our heads why.

1:29

And if you look in the radiology literature written, uh,

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by, I believe it is Berry a few years back,

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and that's in the Green Journal, the, our,

1:40

our radiology journal.

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They talked about the sacro tubus ligament,

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which I highlight here on our crosshairs arising,

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obviously from the sacrum right here.

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This dark structure fan shape, uh, anatomically

1:55

and takes contributions from the sacrum

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and, uh, coys,

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but also serves as an origin for the, uh, portions

2:04

of the gluteus maxis muscle.

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As we can see here, it, it starts originates as a fan shape.

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Structure dovetails itself as it walks, uh,

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or, uh, uh, travels anterior inferiorly

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and laterally towards, uh,

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its insertion upon the isum, okay?

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Or the ischial condylar tuberosity as we see here.

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But then here at the is condylar tuberosity,

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the neat thing is it sort of fans out

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and sends some major contributions to the biceps femoris

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and semi tendinosis origin, okay?

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And, uh, you could even probably hallucinate here, arguably,

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and we can argue it probably sending some fibers here also

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to towards the semimembranosus origin as well.

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And in this case, so the neat thing is,

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and as shown by Dr. Barry, uh,

2:53

and colleagues in their article, if this, uh,

2:56

ligament is not

2:58

Torn, that is intact, it can actually act as, um,

3:04

a stabilizer, if you will,

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or basically a tether to keep the torn hamstring complex

3:11

from disciplinary retracting.

3:12

So if you ever see that, uh, something to think about

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and, uh, and maybe helps us explain why, uh,

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some hamstring tendon tears, distal retract, and some don't.

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Okay. Whether this, uh, will lead to pno prognostic values

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for our surgeons.

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Uh, I think the article mentions, uh, it, it remains

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to be seen, but it'd be a nice thing for, uh, you know,

3:36

a radiologist or interested parties to look into.

3:39

The other thing anatomically I just wanna highlight here is,

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uh, this structure right here,

3:45

this little dark band right here, rising a little bit more

3:49

anterior inferiorly and medially to the hamstring complex.

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And this is what's actually called,

3:55

this is actually an origin of the adductor magnus muscle.

3:58

Okay? And here I have, I pulled up, I took the liberty

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of pulling up the ar pertinent article for this,

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and hopefully y'all can see this,

4:06

but here we can see the complex anatomy at the issue,

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condylar footprint,

4:11

and again, the semiosis arising more superior

4:14

and laterally off of its facet.

4:16

Then we have the conjoin tendon,

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or that is the semi tendinosis in the biceps.

4:20

And then ever, so, uh, slightly more anterior inferiorly

4:25

and mely, we have the origin of the adductor magnus.

4:28

Okay? Why is this important here?

4:31

Uh, as shown in this article from a few years back,

4:34

and I'm happy to provide this to, uh, the, for,

4:37

to everyone in the audience by broski at all.

4:41

Um, you don't wanna confuse this intact adductor mag magnus

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tendon or so, the so-called mini hamstring tendon

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as an actual intact hamstring complex proper.

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I've seen it now a few times,

4:54

and it can be really hard, especially for, uh, the more, um,

4:59

chronic tendon tears where this, um,

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the hamstring proper complex may be torn,

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but you have an intact adductor magnus

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or mini hamstring, uh, causing a fake out, if you will.

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Uh, so that, uh, someone may potentially read this as a,

5:18

uh, intact hamstring, uh, tendon

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or a portion of the hamstring complex.

5:23

So a lot of, uh, neat anatomy, uh, here,

5:26

and I'm happy to share some of those PDFs with y'all.

5:29

Um, and, uh, so just to summarize,

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we have the sacro tubus ligament that blends with the

5:36

majority of it blends with the biceps, emus

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and semi tendinosis.

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We have the semiosis, uh,

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more laterally arising from its lateral facet.

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And then more sort of, uh, an medial and inferiorly.

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We have the origin of the adductor magnus,

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or portions of its origin, uh, contributing

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to the so-called mini hamstring tenderly.