Abstract
Objectives:
Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. The purpose of this study was to evaluate the predictors of clinical outcomes after proximal hamstring repairs.
Methods:
A retrospective review of proximal hamstring avulsions undergoing repair between January 2014 and June 2017 was performed. Patients were excluded for skeletal immaturity, previous tear, revision surgery, allograft reconstruction, fracture, subsequent extremity injury or surgery. Independent variables included: patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool (iHOT-12), and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip Score. Secondary outcome measures included satisfaction, visual analog scale (VAS), and level and timing of return to running or sports.
Results:
Of 86 eligible patients, 58 were analyzed (67%), with 29-month mean follow-up. Average age was 51; 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, though runners were less satisfied (p=0.029). At 7.6 months on average, 88% returned to sports, 72% at the same level. Runners less often returned to the same level, and at a decreased number of miles (15.7 vs. 7.8, p<0.001). Post-operatively, SANE scores improved, but average Tegner decreased (5.5 to 5.1). Acute repairs had higher SANE Activity scores. Higher satisfaction without functional difference for those over 50 years (p=0.024).
Conclusion:
Overall, patient satisfaction and functionality were high. There were no significant differences in functional outcome scores based on age, sex, body-mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute repairs had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same pre-injury activity level following proximal hamstring repair.
Functional and patient reported outcomes. Data represented as mean and standard deviation or number and percent as appropriate.
| Functional Outcomes | Overall |
|---|---|
| Tegner Pre-op | 5.5 (1.0) |
| Tegner Post-opa | 5.1 (0.9) |
| Return to running (%, n/N) | 82 (37/45) |
| Time to return to running (mo) | 6.3 (3.8) |
| Return to sport (%, n/N) | 88 (50/57) |
| Time to return to sports (mo) | 7.6 (4.5) |
| Return to same level (%) | 72 (0.5) |
|
|
(n = 45) |
| Overall Satisfaction (1-5) | 4.7 (0.7) |
| Current Activity pain (0-10) | 1.6 (2.2) |
| SANE ADL Pre-op | 60 (35) |
| SANE ADL Post-opb | 97 (6.8) |
| SANE Activity Pre-op | 32 (38) |
| SANE Activity Post-opc | 82 (24) |
| 90-100 | 26 (58) |
| 75-89 | 9 (20) |
| 50-74 | 6 (13) |
| <50 | 4 (9) |
| iHOT-12 score | 99 (16) |
| KJOC Athletic Hip score | 77 (19) |
aMean pre/postoperative difference = 0.4, p<0.001.
bMean pre/postoperative difference = 29.0, p<0.001.
cMean pre/postoperative difference = 39.4, p<0.001.