Summary

Early surgical repair achieves superior outcomes to late repair, suggesting that surgeons should be identifying and operating on these injuries early.

Abstract

Purpose

Avulsion of the proximal hamstring tendons is an uncommon injury. To date, few studies have prospectively evaluated outcomes of surgical repair. The aim of the present study is to review the functional outcomes of surgical repair of proximal hamstring tendon avulsions.

Methods

This is a prospective series of 96 consecutive proximal hamstring surgical repairs in 94 patients, with a median age of 50 years and median follow-up of 33 months (range 12-58). Functional outcomes were assessed using the Perth Hamstring Assessment Tool(PHAT)- a validated scoring system for proximal hamstring injuries.

Results

Significant improvements in functional outcomes were seen across all patients at 1-year follow-up. There was a mean PHAT score improvement of 34.7 points at the one-year follow-up (p<0.001, 95% CI 29.9-39.5). The SF-12 PCS scores showed a significant improvement at 1-year follow-up of 13.8 points (p<0.001, 95% CI 10.7-16.9). These were maintained at final follow-up. Acute repairs had significantly higher improvement in PHAT score with acute patients improving a mean of 38.6 points (p<0.001, 95%CI 32.0-44.3) and chronic patients only improving by a mean of 25.3 points (p<0.001, 95%CI 18.2-33.3) at final follow-up.

Conclusion

This study establishes that surgical repair of proximal hamstring tendon ruptures leads to improved patient outcomes, in both acute and chronic repairs. Early surgical repair, however, achieves superior outcomes to late repair. These results suggest that surgeons should be operating on proximal hamstring avulsions, and preferably in the acute stage.