Outcomes of Revision Versus Primary Repair of Proximal Hamstring Avulsion Injury

Abstract

Background:

Proximal hamstring avulsion injury (PHAI) repairs are increasing with the growing frequency of this pathology. That is why rerupture is increasingly encountered with rare studies reporting this outcome.

Purpose:

To compare the functional outcomes of revision versus primary PHAI surgery as measured by the Parisian Hamstring Avulsion Score (PHAS) and to compare other outcomes scores, return-to-sport status, and complication rates.

Study Design:

Case-control study; Level of evidence, 4.

Methods:

This single-center, matched case-control study was conducted from 2009 to 2023 at a center specializing in sports surgery. It included adults >18 years of age who underwent revision or primary PHAI repair and had a minimum 1-year follow-up. The study involved matching patients who underwent revision surgery to patients who underwent primary surgery at a 1:4 ratio based on age, sex, Tegner Activity Scale (TAS) score before injury, type of rupture, and follow-up duration. Surgical treatment was indicated for complete PHAI, partial tendon avulsion with >2 cm of retraction, or nonresponse to 6 months of nonoperative treatment. Outcomes measured were the PHAS, complication rate including rerupture, TAS score, UCLA activity score, and patient satisfaction.

Results:

The study included 160 patients, with 128 in the primary group and 32 in the revision group. The mean age for the primary group was 48.6 years (SD, 9.4 years), and for the revision group, it was 48.8 years (SD, 9.4 years); both groups had similar follow-up periods: 45.5 months (SD, 39.5 months) for the primary group and 51.0 months (SD, 46.5 months) for the revision group. Allograft usage was substantially higher in the revision group at 37.5% (12/32) compared with 9.4% (12/128) in the primary group (P = .0003). At the final follow-up, PHAS values were lower in the revision group with a median of 85.0 (IQR, 64.5-92.0) versus 91.5 (IQR, 78.5-97.0) in the primary group (P = .01). The rerupture rate also differed significantly, standing at 31.3% (10/32) in the revision group compared with only 3.9% (5/128) in the primary group, with Kaplan-Meier and Cox regression analyses confirming a higher risk of rerupture, quantified as 8.19 (95% CI, 2.76-24.3; P < .001) times more likely. There were more complications in the revision group (15.6%) compared with the primary group (2.3%) (P = .02). TAS and UCLA scores did not show significant differences (P > .05). Rates of return to sport were similarly comparable across the groups (P > .05). Pain reported as none or mild affected 72.4% (89/123) of the primary group, but only 50.0% (11/22) of the revision group, marking a significant difference (P = .01).

Conclusion:

Revision PHAI repair is associated with lower functional scores and nearly 8 times the risk of rerupture compared with primary surgery. Furthermore, it carries a higher rate of complications.