Reconstruction of chronic proximal hamstring avulsion injuries using ipsilateral distal hamstring tendons results in good clinical outcomes and patient satisfaction

  • Jay R. Ebert
  • Nicholas Gormack
  • Peter T. Annear



To report outcomes following proximal hamstring reconstruction employing an ipsilateral distal hamstring tendon autograft, in patients with chronic proximal ruptures.


Six patients presenting with a chronic proximal hamstring avulsion and a medial time from injury of 11.0 months (range 7–18), confirmed via magnetic resonance imaging, underwent proximal hamstring repair using a free graft harvested from the ipsilateral distal hamstrings. Patients were evaluated at 6, 12 and 24 months post-surgery, via the Perth Hamstring Assessment Tool, the Short Form Health Survey, the Lower Extremity Functional Scale, a Patient Satisfaction Questionnaire, the Active Knee Extension and 6 min walk tests, the single and triple hop tests for distance, and isokinetic knee extensor and flexor strength. Knee strength was assessed at 180° and 240°/s (total work, peak and average torque), and both mean absolute scores and limb symmetry indices (LSIs) comparing the operated and non-operated limbs were presented.


Patients demonstrated good clinical improvement throughout the post-operative timeline in all subjective and objective outcomes. Mean knee extensor LSIs had recovered by 12 and 24 months. At 24 months post-surgery, while mean LSIs for knee flexor peak and average torque were at (or above) 90%, a significant difference still existed between the operated and non-operated limbs in knee flexor total work. At 24 months, five patients (83%) were satisfied with the results of the surgery, as well as their ability to return to recreational and sporting activities. There were two adverse events including an early deep vein thrombosis and a secondary surgery to remove a loosened staple.


While isokinetic hamstring strength had not fully recovered by 24 months, this surgical technique demonstrated a high level of patient satisfaction and return to function, in patients with chronic proximal hamstring ruptures. As the clinical relevance, this surgical technique provides a viable option with good post-operative outcomes for patients with chronic proximal hamstring tears that cannot be approximated back to the ischium.

Level of evidence



Proximal hamstring avulsion Chronic Clinical outcomes Strength Function Patient satisfaction 



No external funding was used.

Compliance with ethical standards

Conflict of interest

All authors declare no individual conflicts.

Ethical approval

Ethics approval was obtained by the Hollywood Private Hospital (HPH432) and the University of Western Australia (RA/4/1/8829).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Jay R. Ebert
    • 1
    • 3
  • Nicholas Gormack
    • 2
  • Peter T. Annear
    • 2
    • 3
  1. 1.The School of Human Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyAustralia
  2. 2.Perth Orthopaedic and Sports Medicine CentreWest PerthAustralia
  3. 3.Perth Orthopaedic and Sports Medicine Research InstituteWest PerthAustralia

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