Does Time from Injury to Surgery Affect Outcomes Following Surgical Repair of Partial and Complete Proximal Hamstring Ruptures?

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...

Systematic Review of Bracing After Proximal Hamstring Repair

“…Of the 26 included articles, 7 studies 4 , 18 , 25 , 26 , 31 , 38 , 41 (n = 291 patients) reported on nonbracing postoperatively, and 19 studies ‖ (n = 985 patients) reported on some form of postoperative bracing. Five of the studies on bracing used hip bracing to limit excessive hip flexion postoperatively, 3 , 12 , 36 , 39 , 45 11 of the studies used a knee brace to limit excessive knee extension, 1 , 2 , 6 , 8 , 9 , 19 - 22 , 24 , 34 and 2 of the studies 29 , 37 used combined hip and knee bracing to limit both excessive knee extension and hip flexion. Table 1 further summarizes the characteristics of the braced and nonbraced studies, including complication rates.…”

“…In the two nonbraced studies that reported LEFS (n=73), average scores from the LEFS, reported as percentages, were found to be 87% and 89%, correlating to raw scores of 69.6 and 71.2 out of a maximum of 80 points, respectively. 25 , 41 There were 5 braced studies 1 , 6 , 8 , 12 , 39 that used the LEFS; the mean LEFS score among these studies was 74.9 (range, 73.3-77). The PHAT, which is measured on a scale of 0 to 100, was used in 1 nonbraced study, 4 in which the mean score was 76 at the final follow-up.…”