Proximal hamstring tears are uncommon and poorly understood. A survey was conducted via SurveyMonkey of a Facebook group, Proximal hamstring ruptures and surgery.
The aim is to report patient's experiences, difficulties and reported outcomes order to guide future practice and patient care, with 737 responses.
The commonest sufferer is a middle aged female, the mechanism was sport in over 50% and a simple trip in 35%. There was no pain preceding the injury in 72%. 42% of tears were retracted between 1-4 cm, 27% 5-8cm and 12% over 8cm.
Nerve pain was reported by 67% of patients at some stage during their treatment, worryingly 17% reported pain after surgery, but not before.
Although 56% of injuries were diagnosed within 2 weeks, diagnosis is frequently delayed, 20% took over 3 months for their diagnosis to be made. 47% of people saw 2-3 healthcare practitioners prior to getting a diagnosis, 19% saw more than 3. Once the diagnosis was made, 40% of patients consulted 2-3 practitioners before deciding upon treatment.
41% of respondents did not attempt conservative treatment prior to surgery, 70% had surgery. 54% waited less than a month for surgery, 16% over 6 months.Of those treated conservatively 42% had treatment for longer than 6 months.
Most surgeons used a buttock crease incision and suture anchors. 35% had no thromboprophylaxis, and 28% no antibiotics.
30% were unbraced after surgery, various hip and knee braces were used in the remaining respondents. 15% were placed at 90 degrees knee flexion resulting in significant issues with stiffness. 4% of patients did not have weight bearing restrictions post operatively while 36% were non weight bearing for 6 weeks. Return to sport took 6 months in 34%, 12 months in 28% and 25% reported they have been unable to do so.
35% reported no complications. Respondents reported buttock pain (28%), hamstring pain (19%), nerve pain (24%), knee pain (22%). Re-tear rate was 8%. The incidence of thrombosis was 2%.
Proximal hamstring rupture patients report a 65% complication rate, with many seeking several opinions before obtaining surgery. The rate of suspected iatrogenic nerve injury (17%), persisting pain and delayed recovery are major concerns.