2017 ISAKOS Biennial Congress ePoster #901

 

Surgical Repair Of Proximal Hamstring Rupture: Postoperative Clinical Outcomes In 174 Patients From A Prospective Cohort

Nicolas Lefevre, MD, Paris FRANCE
Shahnaz Klouche, MD, Paris FRANCE
Antoine Gerometta, MD, Paris FRANCE
Yoann Bohu, MD, Paris FRANCE
Serge Herman, MD, Paris FRANCE

Clinique du Sport, Paris, FRANCE

FDA Status Cleared

Summary

In this prospective cohort study, functional outcomes of surgical repair of proximal hamstring ruptures were excellent. A delay of surgery leads to a higher risk of postoperative complications.

Abstract

Introduction

The proximal hamstring rupture is a rare and little known disease, the first cases have been reported in 1987. Surgical repair is the rule as it showed its superiority compared to medical treatment on different functional criteria. The published series usually include few patients, complications are not reported and the failure risk factors are little analyzed. The main objective of this study was to analyze postoperative outcomes of a large monocenter cohort of patients operated on by experienced surgeons.

Methods

A prospective cohort study has started in our orthopedic center in 2002 and has included all patients of 3 senior surgeons, operated on for a proximal, total or partial, acute (<28 days between injury and surgery) or chronic (>28 days) hamstring rupture. A retrospective analysis of data collected prospectively has concerned a continuous series of patients operated on between 2002 and 2015 and having at least 6-month follow-up. The surgical technique and rehabilitation protocol were the same for all. The primary endpoint was the return to sport. The secondary endpoints were the incidence of postoperative complications, the rate of rerupture and the patient satisfaction at last follow-up. The study was approved by an institutional review board and was declared in a clinical trial register.

Results

This study included 174 patients, 106 men and 68 women, mean age 41.9 years. The injury occurred during a sports activity in 124 (71.3%) patients, a domestic, workplace or road traffic accident in 50 (28.7%) patients. The most frequently found sports were skiing (17.7%), jogging (14.5%), football (12.9%) and rugby (12.1%). The ruptures were usually chronic (53% of patients with an average evolution duration of 6.8 months). 122 (70.1%) patients resumed a sport, the main risk factors for non-recovery were chronic ruptures (49% vs 89%, p<10-5) and non-sporting injuries (37% vs 84% , p<10-5). In early postoperative period, 5 (2.8%) large compressive hematoma occurred (4 acute ruptures and 1 chronic rupture) requiring surgical evacuation for 3 of them and reintegration of tendons for the other 2. The rerupture rate was 3.4% (6/174), all occurred in the chronic ruptures group. A surgical neurolysis was necessary in 2 chronic ruptures among hyperalgic patients. 167 (96%) patients were satisfied or very satisfied with their outcomes at the last follow-up.

Conclusion

Functional results of surgical repair of proximal hamstring ruptures are excellent. A chronic rupture (> 28 days) leads patients to a higher risk of complications, and a less satisfactory recovery.