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. 2019 Feb 15;7(2):2325967118823712.
doi: 10.1177/2325967118823712. eCollection 2019 Feb.

Predictors of Clinical Outcomes After Proximal Hamstring Repair

Eric N Bowman  1 , Nathan E Marshall  2 , Michael B Gerhardt  3 , Michael B Banffy  3
Affiliations

Predictors of Clinical Outcomes After Proximal Hamstring Repair

Eric N Bowman et al. Orthop J Sports Med. .

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.

Keywords: hamstring; proximal; repair; running.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: E.N.B. has received educational support from Smith & Nephew. N.E.M. has received educational support from Arthrex, Smith & Nephew, and DJO. M.B.G. has received royalties from Arthrex and is a consultant for Arthrex, Medacta, Ferring Pharmaceuticals, and Stryker. M.B.B. is a paid speaker/presenter for Arthrex and is a consultant for Stryker, MAKO Surgical, and Vericel. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
(A) Clinical presentation of a proximal hamstring tear. (B) Coronal magnetic resonance imaging demonstrating a complete avulsion. (C) Endoscopic view of suture anchor placement in the anatomic footprint on the ischium with sutures passed through the tendon. (D) Final repair construct after reduction.
See this image and copyright information in PMC

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