High-Grade Partial and Retracted (<2 cm) Proximal Hamstring Ruptures

Abstract

Background:High-grade partial proximal hamstring tears and complete tears with retraction less than 2 cm are a subset of proximal hamstring injuries where, historically, treatment has been nonoperative. It is unknown how nonoperative treatment compares with operative treatment.Hypothesis:The clinical and functional outcomes of nonoperative and operative treatment of partial/complete proximal hamstring tears were compared. We hypothesize that operative treatment of these tears leads to better clinical and functional results.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review identified patients with a high-grade partial or complete proximal hamstring rupture with retraction less than 2 cm treated either operatively or nonoperatively from 2007 to 2015. All patients had an initial period of nonoperative treatment. Surgery was offered if patients had continued pain and/or limited function refractory to nonoperative treatment with physical therapy. Outcome measures were each patient’s strength perception, ability to return to activity, Lower Extremity Functional Scale (LEFS) score, Short Form–12 (SF-12) physical and mental component outcome scores, distance traversed by a single-leg hop, and Biodex hamstring strength testing.Results:A total of 25 patients were enrolled in the study. The 15 patients who were treated nonoperatively sustained injuries at a mean age of 55.73 ± 14.83 years and were evaluated 35.47 ± 30.35 months after injury. The 10 patients who elected to have surgery sustained injuries at 50.40 ± 6.31 years of age (P = .23) and were evaluated 30.11 ± 19.43 months after surgery. LEFS scores were significantly greater for the operative group compared with the nonoperative group (77/80 vs 64.3/80; P = .01). SF-12 physical component scores for the operative group were also significantly greater (P = .03). Objectively, operative and nonoperative treatment modalities showed no significant difference in terms of single-leg hop distance compared with each patient’s noninjured leg (P = .26) and torque deficit at isokinetic speeds of 60 and 180 deg/s (P = .46 and .70, respectively).Conclusion:Patients who undergo operative and nonoperative treatment of high-grade partial and/or complete proximal hamstring tears with <2 cm retraction demonstrate good clinical and functional outcomes. In our series, 40% of patients treated nonoperatively with physical therapy went on to have surgery. For those patients with persistent pain and/or loss of function despite conservative treatment, surgical repair is a viable treatment option that is met with good results.

Evolution of isokinetic strength and return to sport after proximal hamstring rupture without surgical repair: a retrospective series of cases.

“…However, values were variable from one patient to another, with a minimal deficit measured at 14% and a maximal one Table II. Pre-injury (left column) and post-injury (right column) sport and level of Discussion The results of non-surgical management of proximal hamstring ruptures are usually considered not as good as those after surgery (11,14,20). However, after elimination of bone tears, only few cases of non-operated patients have been described, which is responsible for a lack of evidence to conclude formally in favor of the surgical management (11).…”

“…Yet, surgery remains controversial because of the absence of randomized prospective study (10,11). Traumatic complete rupture of the hamstrings with a retraction of more than 2 centimeters, diagnosed in the first 4 weeks in young athletes seems to be the best surgical indications (2,10,(12)(13)(14)(15). Complications after surgery may occur, such as rupture recidivism (2.1 to 2.8%) and superficial infections (2.4 to 3.25%) (10,11).…”

“…In third intention, corticosteroid or platelet rich plasma injections may be proposed (24). In case of failure of these medical therapeutics, surgery remains possible (13,14). Given the lack of knowledge about non-operated proximal ruptures of the hamstrings, the aim of this study was to described the evolution of a series of patients with non-operated hamstring injuries, especially in terms of strength recovery, self-satisfaction and return to sport.…”

Proximal Hamstring Injuries: Review of Operative and Nonoperative Management

“…Still, patient reported outcomes were inferior following nonoperative management, and 40% of patients initially treated nonoperatively eventually elected for surgical intervention. 81 Patients with true proximal hamstring tendinopathy often respond well to nonoperative treatment protocols focused on eccentric strengthening. 79 While the addition of shockwave therapy to a nonoperative treatment protocol has shown promising results in high-level athletes, 68 the role of other modalities or injectable agents, including platelet-rich plasma or corticosteroids, remains unclear with further high-level evidence required before routinely implementing their use in conjunction with established protocols.…”

“…Unlike complete avulsions where the acuity of surgery appears to significantly influence clinical outcomes, the time required of appropriate initial nonoperative management does not negatively influence outcomes if delayed surgical repair is eventually required. 81,[89][90][91][92] Open surgical approaches have traditionally been utilized for operative repair of proximal hamstring injuries. Patients are typically positioned prone while under general anesthesia with adequate prepping and draping of the entire involved lower extremity as well as the buttock and lower back of the operative side.…”