Background:The early repair of acute proximal hamstring ruptures provides better clinical results than delayed repair. However, it is unclear how nonoperative treatment compares with the operative treatment of these injuries.Purpose:To compare the clinical results of the nonoperative and operative treatment of acute proximal hamstring ruptures.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 25 patients with complete, retracted proximal hamstring ruptures presenting to 1 institution were retrospectively reviewed. All patients were given the option of proximal hamstring repair at the time of the initial evaluation. Patients with at least 12 months of follow-up from the time of surgery or injury were included in the evaluation. Both nonoperative and operative treatment groups were evaluated using the same outcome measures. The primary outcome measure was the Lower Extremity Functional Scale (LEFS). Secondary outcome measures included the Short Form–12 (SF-12) physical and mental component summaries, strength testing, a single-leg hop test, the patient’s perception of strength, and the ability to return to activity.Results:There were 11 patients treated nonoperatively, with a mean follow-up of 2.48 ± 3.66 years, and 14 patients treated operatively, with a mean follow-up of 3.56 ± 2.11 years. The mean LEFS scores for the nonoperative and operative groups were 68.50 ± 7.92 and 74.71 ± 5.38, respectively (P = .07). No statistical differences were found between the groups regarding SF-12 scores and mean single-leg hop distance compared with the uninjured leg. Isometric testing of the injured hamstring in the nonoperative group demonstrated significant clinical weakness compared with the uninjured side at both 45° and 90° of flexion (57.54% ± 7.8% and 67.73% ± 18.8%, respectively). Isokinetic testing of the injured leg in the operative group demonstrated 90.87% ± 16.3% strength of the uninjured leg. All patients in the operative group were able to return to preinjury activities, whereas 3 patients in the nonoperative group were unable to return (chi-square = 4.33, P = .07).Conclusion:Patients with acute proximal hamstring ruptures treated surgically regained approximately 90% strength of the uninjured extremity and tended to have a greater likelihood of returning to preinjury activities than patients treated nonoperatively.

Background: No previous study has compared the outcomes of repair for partial and complete proximal hamstring ruptures at various intervals after the injury. Purpose: The primary aim was to determine whether time from injury to surgery affected outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim was to assess patients’ experiences from initial evaluation to finding a treating surgeon. Study Design: Cohort study; Level of evidence, 3. Methods: Records from 2007 to 2016 from a single surgeon’s practice were reviewed. A total of 124 proximal hamstring repair procedures in 121 patients were identified. There were 92 patients who completed questionnaires: a custom survey, the standard Lower Extremity Functional Scale (LEFS), a custom LEFS, the standard Marx activity scale, a custom Marx activity scale, and the University of California Los Angeles (UCLA) activity score. Results were analyzed for partial and complete repair procedures performed at ≤3 weeks, ≤6 weeks, and >6 weeks after the injury. Results: The mean follow-up was 43 months (median, 38 months). Of 93 repair procedures reviewed, 51% (9/28 partial; 38/65 complete), 79% (16/28 partial; 57/65 complete), and 22% (12/28 partial; 8/65 complete) were performed at ≤3 weeks, ≤6 weeks, and >6 weeks, respectively. At those various intervals, no statistical difference was found in standard LEFS, custom LEFS, standard Marx, custom Marx, or UCLA scores. Female sex, older age, and body mass index >30 kg/m2 were negative predictors of outcome measures. When repaired >6 weeks after the injury, a greater percentage of patients reported weakness of the operative leg compared with the contralateral side (partial tears: 6.3% vs 25%, respectively; complete tears: 24.6% vs 50%, respectively) in addition to greater sitting intolerance (partial tears: 0% vs 25%, respectively; complete tears: 7.1% vs 12.5%, respectively). Patients repaired >6 weeks after the injury visited, on average, 2.6 practitioners before an evaluation by the treating surgeon compared with 1.6 treated surgically at ≤6 weeks ( P = .008). Conclusion: Patients with proximal hamstring repair performed in the acute and chronic settings can expect successful outcomes but may experience more subjective weakness and difficulty with prolonged sitting when the repair is performed >6 weeks after the injury. Patients faced challenges in receiving the correct diagnosis and referral to an appropriate treating surgeon, emphasizing the need for an increased awareness of the injury.

No abstract

Objectives:The purpose of this study was to determine if time from injury to surgery affected postoperative outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim of the study was to assess patients’ experiences from initial evaluation to finding a treating surgeon to help increase awareness of the injury.Methods:Office records from 2008 to 2016 were reviewed from one orthopedic surgeon’s practice. A total of 124 partial and complete proximal hamstring repairs in 121 patients were identified. Ninety-two patients completed questionnaires including a custom survey in addition to validated outcome measures: Lower Extremity Outcome Score (LEFS), custom LEFS, Marx Activity Scale, custom Marx scale, and University of California at Los Angeles (UCLA) Activity Score. A chart review was performed to collect demographic, encounter, and operative information. Results were analyzed and compared for both partial and complete proximal hamstring repairs performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks following injury.Results:Mean follow-up of study respondents was 43 months (range, 6-116 months). Of the 93 proximal hamstring repairs reviewed, 50.5% (9/28 partial, 38/65 complete), 78.5% (16/28 partial, 57/65 complete) and 21.5% (12/28 partial, 8/65 complete) were performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks, respectively. At various injury-to-surgery time intervals, no statistical difference was found in the LEFS, custom LEFS, Marx Activity Scale, custom Marx Scale, and UCLA Activity Scores. Overall, partial proximal hamstring repairs had better outcome scores compared to complete tears although this was not statistically significant with the exception of leg pain at rest, which was higher after repair of complete tears (P = 0.021). Additionally, female gender and age were negative predictors of outcome scores. Increasing time from injury-to-surgery was associated with lower perceived strength of operative side compared to contralateral leg, most notable with surgery > 6 weeks after injury (% patients with perceived near or full strength of the contralateral limb: partial tears ≤ 6 weeks 93.8% versus > 6 weeks 75%; complete tears ≤ 6 weeks 75.4% versus > 6 weeks 50%). Patients who underwent repair > 6 weeks following injury for both partial and complete tears exhibited a greater sitting intolerance after one hour compared to those repaired ≤ 6 weeks (0% partial, 7.1% complete ≤ 6 weeks; 12.5% partial, 25% complete > 6 weeks). The majority of patients with complete ruptures (42%) were initially evaluated at a local emergency room while most partial tears were evaluated by their primary care physician (35.7%). Patients with repairs performed > 6 weeks following injury visited, on average, 2.6 practitioners prior to evaluation by the treating surgeon compared to 1.6 for those surgically treated ≤ 6 weeks following injury.Conclusion:Proximal hamstring ruptures performed in both the acute and chronic setting can expect overall successful outcomes but may experience lower perceived strength...