Abstract
Purpose
Although the treatment of choice for acute proximal hamstring ruptures is now surgical repair, this technique is relatively new and requires further evaluation. Our hypothesis was that patients return to sports at the same level after surgical repair as before injury.
Methods
From 2002 to 2011, a prospective observational study including 34 patients, mean age 39.3 ± 11.4 years old underwent surgical repair of an acute proximal hamstring rupture. Surgical, rehabilitation and follow-up protocols were standardized. Mean follow-up was 27.2 ± 22.9 months and there were no lost to follow-up. The primary outcome was the level of activity on the UCLA and Tegner scores.
Results
The mean UCLA score was 9.1 ± 1.3 before injury and 8.7 ± 1.7 at the final follow-up (p = 0.03). The median Tegner activity level was 6 (range, 4–10) before injury and 6 (range, 3–10) at the final follow-up (p = 0.05). The two scores were correlated (r = 0.76, p = 0.00001). Patients returned to sports within a mean 5.7 ± 1.6 months, at the same level in 27 patients (79.4 %) and at a lower level in 7 patients (20.6 %). The average hamstring/quadriceps ratio at 240°/second was 54.7 ± 8.6 % which was positively correlated to the level of activity on the UCLA score (r = 0.49, n.s.). The level of satisfaction was related to their level of activity at the final follow-up (p = 0.03).
Conclusion
Although surgical repair of acute proximal hamstring ruptures has significantly improved the functional prognosis of patients it remains a serious condition that can compromise future sports activities.
Level of evidence
Case–control study, Level III.
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References
Amstutz HC, Thomas BJ, Jinnah R et al (1984) Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg (Am) 66:228–241
Birmingham P, Muller M, Wickiewicz T et al (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg (Am) 93:1819–1826
Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13:411–418
Carmichael J, Packham I, Trikha SP et al (2009) Avulsion of the proximal hamstring origin. Surgical technique. J Bone Joint Surg (Am) 91:249–256
Carmody C, Prietto C (1995) Entrapment of the sciatic nerve as a late sequela of injury to the hamstring muscles. A case report. J Bone Joint Surg (Am) 77:1100–1102
Chakravarthy J, Ramisetty N, Pimpalnerkar A et al (2005) Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature. Br J Sports Med 39:569–572
Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15:350–355
Cross MJ, Vandersluis R, Wood D et al (1998) Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med 26:785–788
Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36:104–109
Harris JD, Griesser MJ, Best TM et al (2011) Treatment of proximal hamstring ruptures: a systematic review. Int J Sports Med 32:490–495
Hernesman SC, Hoch AZ, Vetter CS et al (2003) Foot drop in a marathon runner from chronic complete hamstring tear. Clin J Sport Med 13:365–368
Ishikawa K, Kai K, Mizuta H (1988) Avulsion of the hamstring muscles from the ischial tuberosity: a report of two cases. Clin Orthop Relat Res 232:153–155
Kirkland A, Garrison JC, Singleton SB et al (2008) Surgical and therapeutic management of a complete proximal hamstring avulsion after failed conservative approach. J Orthop Sports Phys Ther 38:754–760
Klingele KE, Sallay PI (2002) Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med 30:742–747
Kwak HY, Bae SW, Choi YS, Jang MS (2011) Early surgical repair of acute complete rupture of the proximal hamstring tendons. Clin Orthop Surg 3:249–253
Kraus TM, Siebenlist S, Sandmann G et al (2009) Non-operative treatment of complete rupture of the proximal hamstring tendons. Acute functional and radiologic assessment with 3-month and 2-year follow up. Injury Extra 40:263–266
Koulouris G, Connell D (2003) Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32:582–589
Lempainen L, Sarimo J, Heikkila J et al (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40:688–691
Orava S, Kujala UM (1995) Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 23:702–705
Sallay PI, Friedman RL, Coogan PG et al (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24:130–136
Sallay PI, Ballard G, Hamersly S et al (2008) Subjective and functional outcomes following surgical repair of complete ruptures of the proximal hamstring complex. Orthopedics 31:1092
Sarimo J, Lempainen L, Mattila K et al (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Wood DG, Packham I, Trikha SP et al (2008) Avulsion of the proximal hamstring origin. J Bone Joint Surg (Am) 90:2365–2374
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The authors thank Mathieu Pinet for his illustrations.
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Lefevre, N., Bohu, Y., Naouri, J.F. et al. Returning to sports after surgical repair of acute proximal hamstring ruptures. Knee Surg Sports Traumatol Arthrosc 21, 534–539 (2013). https://doi.org/10.1007/s00167-012-2204-2
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DOI: https://doi.org/10.1007/s00167-012-2204-2