Predictors of Clinical Outcomes After Proximal Hamstring Repair

Abstract

Background:Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable.Purpose:To evaluate the predictors of clinical outcomes after proximal hamstring repair.Study Design:Case series; Level of evidence, 4.Methods:We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool–12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports.Results:Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes (P = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; P < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years (P = .024), although they were less likely to return to running (P = .010).Conclusion:Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair.Clinical Relevance:When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.

Surgical Treatment of Partial Proximal Hamstring Tendon Tears

“…Patients with complete proximal hamstring tears demonstrated significantly higher mHHS post-operatively compared to partial proximal hamstring tears, corroborating with Barnett et al's data on open repairs [28]. Bowman et al [34] analyzed a sub-cohort of 10 patients treated endoscopically, among an overall cohort of 58 patients treated with open and endoscopic techniques. Authors explained that the study was not adequately powered to detect any meaningful differences between the open and endoscopic sub-cohorts; however, the endoscopic cohort did well in terms of satisfaction, pain, complication rates, and patient-reported functional outcomes.…”

Systematic Review of Outcome Measures Used After Proximal Hamstring Repair

“…One article by Shambaugh et al 34 discussed operative and nonoperative management of proximal hamstring repair; however, only data from patients treated operatively were included in analysis. Quality assessment of studies per the MINORS criteria demonstrated a mean score of 12.9 (range, [11][12][13][14][15]. Given the nature of the clinical research, all included studies had a reduced quality assessment score owing to a lack of control groups, patient groups representative of the general population, and in-depth statistical analysis of data, making their ideal score 16.…”

Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter Study With Minimum 2-Year Follow-up

“…Most of their patients presented within the acute phase (<4 weeks after symptom onset), with minimal complications noted. Furthermore, Bowman et al 4 showed comparable results between open and endoscopic repair of proximal hamstring tendon tears. Kayani et al 20 reported their results with surgical management of chronic partial proximal hamstring tendon tears in a case series that included 41 patients.…”