PURPOSE: The purpose was to evaluate long-term functional outcomes, including patient-reported outcomes (PROs), strength recovery and complications, following surgical repair of complete proximal hamstring avulsions at a minimum 5-year follow-up. We hypothesised that patients would demonstrate sustained functional outcomes with minimal long-term strength deficits.
METHODS: Patients undergoing surgical repair of complete proximal hamstring tendon avulsions at a single institution with ≥5-year follow-up were included. Bilateral injuries were excluded. Data collected included demographics, perioperative characteristics, PROs, isokinetic hamstring strength testing, hip range of motion (ROM), thigh circumference and any postoperative posterior thigh dysesthesia.
RESULTS: The cohort included 35 patients who completed PRO surveys, and 17 who underwent physical exams at a 7.6-year follow-up ± 1.8. Mean age at surgery was 51.3 years ± 9.9, with a 54% male predominance. All tears were complete with a mean tendon retraction of 4.5 cm ± 3.6. Regarding chronicity, 22 patients (63.0%) had acute injuries (<6 weeks from injury to operation) and 12 (34%) had chronic injuries (>6 weeks from injury to operation); one was unreported. The mean duration of symptoms prior to surgery was 111 days ± 219. The mean isokinetic knee flexion torque deficit was 9.5% ± 23.1. The thigh circumference deficit was <1.0% ± 2.1. Mean hip extension asymmetry was 3.5% ± 42.3, and hip flexion asymmetry was <1.0% ± 6.4. There were two reoperations (11.1%). The mean international hip outcome tool (iHOT-12) was 83.3 ± 16.5, lower extremity functional scale (LEFS) 73.8 ± 10.6 (range 32-80), Marx Activity Scales 6.1 ± 5.5, visual analogue scale (VAS) pain 1.4 ± 2.5. The return to sport (RTS) rate was 78%, with mean satisfaction 4.3 ± 1.5.
CONCLUSION: Surgical repair of proximal hamstring tendon avulsions demonstrates long-term durability, with minimal strength or circumference deficits, low complication rates and high RTS and satisfaction maintained at mean 7.6- year follow-up.
LEVEL OF EVIDENCE: Level IV.
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