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. 2021 Oct 29;9(10):23259671211043097.
doi: 10.1177/23259671211043097. eCollection 2021 Oct.

Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center

Raymond Best  1   2 , Anorte Meister  1 , Malin Meier  1 , Jochen Huth  1 , Ulrich Becker  1
Affiliations

Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center

Raymond Best et al. Orthop J Sports Med. .

Abstract

Background: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge.

Purpose/hypothesis: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient's functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery.

Study design: Case series; Level of evidence, 4.

Methods: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery.

Results: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores (P = .003; r = -0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores (P = .525; r = -0.06).

Conclusion: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.

Keywords: functional outcome; hamstring repair; predictive factors; proximal hamstring avulsion; time of surgery.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. 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.
Operation site of a 56-year-old female patient with a right-sided injury; the time of surgery was 9 weeks after trauma. After longitudinal incision, the sciatic nerve was identified and neurolysis performed. The nerve was first marked with a blue vessel loop for further stump dissection. SN, sciatic nerve; TS, tendon stump.
Figure 2.
Figure 2.
(A) Magnetic resonance imaging measurement of a right-sided injury 1 week after trauma. Detailed view: (B) measurement of biceps tendon and (C) measurement of semitendinosus tendon. IT, ischial tuberosity; SN, sciatic nerve; TS, tendon stump.
Figure 3.
Figure 3.
Age distribution in years at time of surgery.
Figure 4.
Figure 4.
Time to surgery (weeks) in relation to Perth Hamstring Assessment Tool (PHAT) score. Boxes represent interquartile range, whiskers represent overall range, X's show the mean, crosslines indicate median, and circles represent outliers.
Figure 5.
Figure 5.
Timing of surgery (acute, chronic, or delayed) in relation to Perth Hamstring Assessment Tool (PHAT) score.
See this image and copyright information in PMC

References

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