Avulsion of the proximal hamstring tendon from the ischial tuberosity is an uncommon but significant injury. Typically associated with sudden hip flexion and knee extension most frequently involving the biceps femoris-semitendinosus conjoint tendon at the ischial tuberosity. Non-operative treatment is associated with persistent pain, decreased function, secondary sciatic symptoms and delayed return to activity. A growing body of evidence suggests that surgical repair of proximal hamstring avulsions results in improved clinical outcomes when compared to non-operative management.
Patients that underwent proximal hamstring repair from 2 surgeons over a 4 year period were assessed. A total of 63 patients were identified for their surgical outcomes, and 34 patients were successfully contacted for patient reported assessment. This included mechanism of injury, time to surgery, pre and post injury Tegner scores, Lower Functional Extremity Score (LFES) and Perth Hamstring Assessment Tool score (PHATS). Current hamstring symptoms, further injuries and overall satisfaction were also recorded.
Of the 63 patients identified, 49 patients had acute repairs (<6 weeks), average age 50.3, 14 underwent repair of chronic injuries (average of 6.7 months chronicity, SD 3.1), average age 47.9. Complications occurred in 11% of patients. In patients with acute repairs average pre-injury Tegner was 4.7, and in patients with chronic repairs, pre-injury Tegner was 3.6 indicating a lower activity cohort. When compared to chronic repairs at follow up, acute repairs had greater PHAT scores (86 vs 53.8), LFES (74 vs 58), Tegner (4.4 vs 3.1), patient satisfaction (100% vs 71.5%), and less pain (1.4 vs 3.4). Three out of seven patients in the chronic group had further hamstring injuries.
Operative management of proximal hamstring avulsions results in good overall outcomes and patient satisfaction with a relatively low complication rate. Ongoing prospective data collection will minimize loss to follow up. Repair of chronic injuries is associated with poorer outcomes, less patient satisfaction and higher re-injury rates when compared to acute repairs.