Abstract
Objectives:
Proximal hamstring tendon avulsions are classically reported as injuries sustained by males during sporting activities (e.g., water skiing and sprinting). A small number of studies focused on female athletes suggest that these injuries are also common in this population. Few prior studies have directly compared mechanism of injury between males and females in the general populace or evaluated additional injury characteristics such as time from injury to repair/reconstruction and degree of tendon retraction. The present study seeks to address this gap. We hypothesized that females would be more likely than males to present with chronic and low energy mechanisms of injury seen in activities of daily living (ADL). We also hypothesized that males would sustain injuries with greater tendon retraction and have less time from injury to primary repair/reconstruction.
Methods:
We performed a retrospective review of prospectively collected data from 2013-2024. Patients included were 18-75 years old, underwent primary proximal hamstring tendon repair/reconstruction, and had between 5-7 months of postoperative follow-up. Primary variables of interest were sex, mechanism of injury, time from injury or symptom onset to surgery, number of tendons involved, and degree of retraction. We also included age and BMI as covariates. Mechanism of injury was blinded to sex and separated into 4 categories – sport, ADL, chronic, and trauma. We utilized 4 raters to achieve 100% inter-rater agreement. Continuous variables were summarized in the results as median and interquartile range (IQR).
Results:
117 patients were included in the analysis (45% male, 55% female). Male and female patients did not differ significantly by age [Male: 57 yrs (48,62); Female: 52 yrs (44,58), p = 0.07] or number of tendons torn [Male: 3.0 (3.0,3.0); Female: 3.0 (2.5,3.0), p = 0.09]. Males and females differed significantly by mechanism of injury (p = 0.011) with a larger proportion of males being injured in sport (74% of male patients vs. 48% of female patients) and a larger proportion of females being injured in ADLs (39% of females vs. 21% of males). Despite this difference, females were still most commonly injured during sport (48%) compared to ADLs (39%), trauma (1.6%), and chronic/overuse mechanisms (11%). Females were also more likely than males to undergo primary repair/reconstruction for chronic tendon tears (11% of females vs. 1.9% of males), while males had significantly higher BMI [Male: 27 (24,29); Female: 24, (22,29), p = 0.008] and degree of tendon retraction [Male: 3.8 cm (2.9,5.9); Female: 3.0 cm (2.0,5.0), p = 0.046]. Finally, female patients underwent a statistically significant delay in time to surgery compared to their male counterparts (Male: 2.3 weeks (1.6, 5.6); Female: 4.3 weeks (2.0, 22.0), p = 0.004].
Conclusions:
The present study supports an updated perspective on the clinical presentation of proximal hamstring avulsion injuries. Specifically, a modest proportion of patients with these injuries are middle-aged women engaging in lower-energy activities of daily living and not males participating in high energy sports. This finding should aid clinicians in accurately diagnosing patients with proximal hamstring avulsions and has important clinical implications for how quickly patients can be indicated for surgical repair.
