Surgical Management of Chronic Incomplete Proximal Hamstring Avulsion Injuries

Abstract

Background: Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence. Hypothesis: Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence. Study Design: Case series: Level of evidence, 4. Methods: This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery. Results: All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up. Conclusion: Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.