Complete hamstring proximal avulsions can occur in adults but are unusual with small series reported often involving forceful flexion of hip when the knee is extended during athletic activity, particularly waterskiing [92-96]. They can be treated with surgical intervention with good outcomes in the acute and chronic setting although acute intervention may be preferred [94,97,98].
Importantly, when avulsive injuries (particulary of the lesser trochanter) occur in older adults without history of significant trauma, one must consider underlying malignant process until proven otherwise [99-101] (Fig. 22).
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