Subjective and Functional Outcomes Following Surgical Repair of      Complete Ruptures of the Proximal Hamstring Complex

Sallay, Peter I.; Ballard, Gregory P.; Hamersly, Scott F.; Schrader, Monica

doi:10.3928/01477447-20081101-26

Cited by 70 publications

(88 citation statements)

References 13 publications

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“…Studies have found that acute repair leads to improved results and an easier repair, while late repair often requires specialized skill for surgical repair due to higher risks (tendon retraction and nerve injury) and lower functional outcomes. 4,6,9,16,18 As with most if not all tendon injuries, early repair of the tendon tear generally results in more favorable outcomes. In general, acute management is considered when the repair is performed within 4 weeks of injury.…”

Section: Discussionmentioning

confidence: 99%

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Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

et al. 2012

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Background: The purpose of this study was to assess postsurgical outcomes in active patients after primary repair of acute and chronic proximal hamstring tears. Hypothesis: Surgical treatment of both acute and chronic proximal hamstring avulsion injuries would result in improved patient outcomes using validated outcome scores and a hamstring-specific questionnaire, and operative repair of these injuries results in excellent outcomes with a high level of patient satisfaction, pain relief, and return to function. Study Design: Case series; Level of evidence, 4. Methods: Fifty-two patients who underwent proximal hamstring repair (26 male and 26 female; average age, 47.7 years) completed the Lower Extremity Functional Scale (LEFS), a custom LEFS, the Marx Activity Scale, a custom Marx scale, a proximal hamstring score (which combines the sum of the custom LEFS and Marx), and a proximal hamstring questionnaire with subjective questions. Forty patients were characterized as having acute repairs, and 12 patients had chronic repairs. All patients underwent surgical repair with 5 suture anchors on the ischial tuberosity through a transverse incision. The rehabilitation protocol was also similar with the use of a hip orthosis for 6 to 8 weeks, allowing progressive weightbearing and range of motion. Results: The mean follow-up in our study was 33 months (range, 12-76 months). The mechanism of injury in 28 patients was eccentric hip flexion and knee extension in the ipsilateral knee typically caused by a slip and fall accident. One patient’s injury was caused by trauma to the proximal hamstring. In 23 patients, hamstring injuries were sports related. Overall, 51 (98%) were satisfied with their outcome after surgery. The LEFS, Marx, custom LEFS, custom Marx, and proximal hamstring scores for patients with acute injuries were 76.2, 10.0, 71.4, 20, and 91.7, respectively. For those with chronic injury, the scores were 71.5, 10.4, 70.8, 18.7, and 89.8, respectively. The scores were not statistically different for LEFS, Marx, custom LEFS, and proximal hamstring scores ( P = .22, P = .6, P = .72, and P = .6, respectively). Patients with acute injury did have a greater custom Marx score ( P = .001). Postoperatively, 5 patients (9.6%) had burning pain or numbness in the posterior thigh or foot, and 25 (48%) had at least some discomfort sitting. Thirty-five patients (67%) reported they could participate in strenuous activities at their latest follow-up. All patients estimated their strength recovery at ≥75%. Conclusion: Results of this study indicate successful outcomes for both acute and chronic repairs, although patients with the acute repairs had higher functional and hamstring scores, and estimated hamstring strength.

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Section: Discussionmentioning

confidence: 99%

“…6,7,16 Patients who sustain a violent eccentric contraction of the hamstring during knee extension and hip flexion typically feel a sharp pop or pull near the buttocks. They classically present with significant ecchymosis about the posterior thigh, difficulty ambulating, and significant sitting pain.…”

Section: Discussionmentioning

confidence: 99%

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

et al. 2012

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“…Surgeons are more likely to recommend repair of proximal hamstring-origin complete avulsions because of the risk for tendon retraction and progressive functional impairment with time [29], whereas the majority of hamstring muscle injuries respond well to nonoperative treatment [5,36]. In a review of hamstring injuries, Linklater et al [29] note that ''proximal hamstring avulsions are of particular importance because of the substantially improved outcome with early surgical repair''.…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Imaging of an Untreated Grade III Hamstring Tear: A Case Report

Clark

Henn

Lovering

2011

Clinical Orthopaedics &Amp; Related Research

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Background Muscle strains are one of the most common complaints treated by physicians. High-force lengthening contractions can produce very high forces resulting in pain and tissue damage; such strains are the most common cause of muscle injuries. The hamstring muscles are particularly susceptible as they cross two joints and regularly perform lengthening contractions during running. We describe a patient with return to full function after a large hamstring tear. Case Description We report the case of a 26-year-old man who presented 1 year after a noncontact, left-sided proximal hamstring tear incurred while sprinting. He received no medical treatment or formal rehabilitation. He was able to return to all sports and activities 1 to 2 months after injury, but noted a persistent deformity of the proximal thigh, which led him to seek evaluation. Physical examination, MRI functional tests, and specific muscle tests 1 year after his injury documented a major hamstring tear at the musculotendinous junction with muscle retraction, but no avulsion of the proximal tendon attachment. Literature Review Surgery often is recommended for major proximal hamstring tendon tears, especially when more than one tendon of origin is ruptured from the ischial tuberosity. Myotendinous tears are treated nonoperatively, but may be associated with decreased strength, prolonged recovery, and recurrence. Purpose and Clinical Relevance We describe the case of a young man who sustained a hamstring tear, with retraction, at the proximal myotendinous junction, where the biceps femoris and semitendinosus arise from the conjoint tendon. He achieved full functional recovery without medical attention, but had a persistent cosmetic deformity and slight hamstring tightness. This case suggests a benign natural history for this injury and the appropriateness of noninvasive treatment.

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“…12,22,39,40 The surgical procedure and self-reported postoperative outcomes are described in several works. 13,14,26,36 Return to preinjury level of sport and patient satisfaction are usually used as main outcomes after undergoing repair of proximal hamstring tendon rupture. 9,28,37,41 Isokinetic muscle strength has been used as a performance-based outcome, showing a mean limb symmetry index (LSI) between 80% and 95%, although most of the studies have included few patients.…”

Section: Introductionmentioning

confidence: 99%

“…20 Patients usually experience a pop or a snap and severe pain in the buttock when the injury occurs, followed by swelling and bruising of the thigh, hamstrings weakness, and decreased function in the injured lower limb. 14,36 Surgical repair is recommended when at least 2 tendons are ruptured and retraction of the ruptured tendons is ≥ 2 cm. 7,12,13 A recent systematic review by Harris et al 20 showed that acute repair (within 4 weeks) resulted in significantly better patient satisfaction, subjective outcomes, pain relief, strength and endurance, and a higher rate of return to sport compared with chronic repair (after 4 weeks).…”

Section: Introductionmentioning

confidence: 99%

Self-Reported and Performance-Based Functional Outcomes After Surgical Repair of Proximal Hamstring Avulsions

et al. 2013

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This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Skaara, H. E., Moksnes, H., Frihagen, F. J., Stuge, B. (2013 Purpose: To examine lower extremity function after surgical repair of proximal hamstring avulsions using validated self-reported and performance-based functional outcomes. Study Design: Case seriesMethods: Operative records from 2006 to 2010 were retrospectively reviewed in 3 hospitals.A total of 39 patients who undergone surgical repair of proximal hamstring avulsion were identified and 36 met the inclusion criteria. Thirty-one patients completed questionnaires with demographic background data and quality of life related questions, Lower Extremity Functional Scale (LEFS) and Proximal Hamstring Injury Questionnaire (PHIQ). Thirty patients were evaluated using a Biodex dynamometer for isokinetic quadriceps and hamstring strength measurement at a velocity of 60 deg/s, and 27 patients performed 4 single-legged hop tests.Results: Twenty-eight repairs were acute (< 4 weeks), and 3 were chronic. There were complete ruptures of all 3 tendons in 17 (55%) cases. The mean follow-up was 30 months.Most patients experienced little or no pain or limitations during activities of daily living. The mean LEFS score was 89%, and 29 (94%) of the 31 patients were satisfied with the result 2 after surgery. Eighteen (58%) of the 31 patients had returned to their pre-injury activity level.Significant differences in the mean hamstring strength (peak torque) (P< .001) and single hop for distance (P = .01) between the uninvolved and the involved leg were found. Twenty-two (71%) of the 31 patients did not fully trust their operated leg during physical activities and feared for sustaining a hamstring injury. Return to activity significantly correlated with the single hop for distance test, LEFS and the questions regarding trust and fear. Conclusion:In this study, using both validated self-reported and performance-based outcome measures after surgical repair of proximal hamstring tendon avulsion, minor pain and limitations to activities of daily living were seen. Isokinetic hamstring muscle strength in the operated leg was significantly lower compared to the nonoperated leg, and a majority of the patients did not trust the operated leg completely during physical activity

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Subjective and Functional Outcomes Following Surgical Repair of Complete Ruptures of the Proximal Hamstring Complex

Cited by 70 publications

References 13 publications

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

Functional Results and Outcomes After Repair of Proximal Hamstring Avulsions

Evaluation and Imaging of an Untreated Grade III Hamstring Tear: A Case Report

Self-Reported and Performance-Based Functional Outcomes After Surgical Repair of Proximal Hamstring Avulsions

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