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Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the present study was to validate a new scoring system for proximal hamstring injury—the Perth Hamstring Assessment Tool (PHAT).

Methods

This is a prospective series of 74 consecutive proximal hamstring surgical repairs in 72 patients, with a median age of 50.5 years (range 16–74). Patients completed the PHAT, SF12 Health Survey and Lower Extremity Functional Scale (LEFS). The scoring system was validated by calculating its internal consistency, reproducibility, reliability and sensitivity to change. Construct validity was evaluated using Pearson’s correlation analysis to examine the strength of association between the PHAT, LEFS and SF-12 scores.

Results

The PHAT showed high completion rate (100 %), high internal consistency (Cronbach’s alpha 0.80), high reproducibility (ICC 0.84) and high sensitivity to change. There was moderate correlation with the LEFS and low correlation with the Physical Component Score of the SF-12.

Conclusion

This study has validated the PHAT as an assessment tool for proximal hamstring tendon injuries. The new questionnaire provides a measure of outcome that is reliable and sensitive to clinically important change. This simple questionnaire provides the clinician with a quick and practical tool for assessing patients with proximal hamstring injuries: to assess pre-operative disability and monitor recovery post-operatively.

Level of evidence

II.

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References

  1. Bencardino JT, Mellado JM (2005) Hamstring injuries of the hip. Magn Reson Imaging Clin N Am 13:677–690

    Article  PubMed  Google Scholar 

  2. Binkley JM, Stratford PW, Lott SA, Riddle DL (1999) The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther 79:371–383

    CAS  PubMed  Google Scholar 

  3. Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R (2011) Functional outcome after repair of proximal hamstring avulsions. J Bone Joint Surg Am 93:1819–1826

    Article  PubMed  Google Scholar 

  4. Blasier RB, Morawa LG (1990) Complete rupture of the hamstring origin from a water skiing injury. Am J Sports Med 18:435–437

    Article  CAS  PubMed  Google Scholar 

  5. Bowman KF, Cohen SB, Bradley JP (2013) Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 41:1363–1371

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. Chakravarthy J, Ramisetty N, Pimpalnerkar A, Mohtadi N (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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Cohen SB, Rangavajjula A, Vyas D, Bradley JP (2012) Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 40:2092–2098

    Article  PubMed  Google Scholar 

  9. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    Article  CAS  PubMed  Google Scholar 

  10. Fitzpatrick R, Ziebland S, Jenkinson C, Mowat A, Mowat A (1992) Importance of sensitivity to change as a criterion for selecting health status measures. Qual Health Care 1:89–93

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Floor S, van der Veen AH, Devilee RJ (2010) Two patients with a complete proximal rupture of the hamstring. Arch Orthop Trauma Surg 130:523–526

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M (1998) Cross-validation of item selection and scoring for the SF-12 health survey in nine countries. J Clin Epidemiol 51:1171–1178

    Article  CAS  PubMed  Google Scholar 

  14. Gidwani S, Bircher MD (2007) Avulsion injuries of the hamstring origin—a series of 12 patients and management algorithm. Ann R Coll Surg Engl 89:394–399

    Article  PubMed  PubMed Central  Google Scholar 

  15. Harris JD, Griesser MJ, Best TM, Ellis TJ (2011) Treatment of proximal hamstring ruptures—a systematic review. Int J Sports Med 32:490–495

    Article  CAS  PubMed  Google Scholar 

  16. Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences. Houghton Mifflin, Boston, pp 107–110

    Google Scholar 

  17. 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

    Google Scholar 

  18. Jette DU, Jette AM (1996) Physical therapy and health outcomes in patients with knee impairments. Phys Ther 76:1178–1187

    Article  CAS  PubMed  Google Scholar 

  19. Klingele KE, Sallay PI (2002) Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med 30:742–747

    PubMed  Google Scholar 

  20. Konan S, Haddad F (2010) Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. Int Orthop 34:119–123

    Article  PubMed  Google Scholar 

  21. Kurosawa H, Nakasita K, Nakasita H, Sasaki S, Takeda S (1996) Complete avulsion of the hamstring tendons from the ischial tuberosity. A report of two cases sustained in judo. Br J Sports Med 30:72–74

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lempainen L, Sarimo J, Heikkilä J, Mattila K, Orava S (2006) Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 40:688–691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. van der Made AD, Reurink G, Gouttebarge V, Tol JL, Kerkhoffs GM (2015) Outcome after surgical repair of proximal hamstring avulsions: a systematic review. Am J Sports Med 43:2841–2851

    Article  PubMed  Google Scholar 

  24. Mansour AA, Genuario JW, Young JP, Murphy TP, Boublik M, Schlegel TF (2013) National football league athletes’ return to play after surgical reattachment of complete proximal hamstring ruptures. Am J Orthop 42:E38–E41

    PubMed  Google Scholar 

  25. Marx RG, Fives G, Chu SK, Daluiski A, Wolfe SW (2009) Allograft reconstruction for symptomatic chronic complete proximal hamstring tendon avulsion. Knee Surg Sports Traumatol Arthrosc 17:19–23

    Article  PubMed  Google Scholar 

  26. Mica L, Schwaller A, Stoupis C, Penka I, Vomela J, Vollenweider A (2009) Avulsion of the hamstring muscle group: a follow-up of 6 adult non-athletes with early operative treatment: a brief report. World J Surg 33:1605–1610

    Article  PubMed  Google Scholar 

  27. Murray PJ, Lowe WR (2009) Achilles allograft reconstruction of a chronic complete proximal hamstring rupture. Knee Surg Sports Traumatol Arthrosc 17:1360–1363

    Article  PubMed  Google Scholar 

  28. Orava S, Kujala UM (1995) Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 23:702–705

    Article  CAS  PubMed  Google Scholar 

  29. Sallay PI, Ballard G, Hamersly S, Schrader M (2008) Subjective and functional outcomes following surgical repair of complete ruptures of the proximal hamstring complex. Orthopedics 31:1092

    Article  PubMed  Google Scholar 

  30. Sallay PI, Friedman RL, Coogan PG, Garrett WE (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24:130–136

    Article  CAS  PubMed  Google Scholar 

  31. Sarimo J, Lempainen L, Mattila K, Orava S (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115

    Article  PubMed  Google Scholar 

  32. Skaara HE, Moksnes H, Frihagen F, Stuge B (2013) Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 41:2577–2584

    Article  PubMed  Google Scholar 

  33. Stevens MA, El-Khoury GY, Kathol MH, Brandser EA, Chow S (1999) Imaging features of avulsion injuries. Radiographics 19:655–672

    Article  CAS  PubMed  Google Scholar 

  34. Ware J, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  35. Wood DG, Packham I, Trikha SP, Linklater J (2008) Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 90:2365–2374

    Article  PubMed  Google Scholar 

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Correspondence to William G. Blakeney.

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Blakeney, W.G., Zilko, S.R., Edmonston, S.J. et al. Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool. Knee Surg Sports Traumatol Arthrosc 25, 1936–1942 (2017). https://doi.org/10.1007/s00167-016-4214-y

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