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

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.

Download Full-text

Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab006 ◽

2021 ◽

Author(s):

Shai Factor ◽

Amal Khoury ◽

Ran Atzmon ◽

Matias Vidra ◽

Eyal Amar ◽

...

Keyword(s):

Functional Outcome ◽

Open Repair ◽

Hamstring Tendon ◽

Activity Level ◽

Short Term ◽

The Mean ◽

Proximal Hamstring ◽

Tendon Avulsion ◽

Mini Open

To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20–61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2–43 months). At a mean follow-up of 28 months (range 12–55 months), the average PHAT score was 73 (range 70–80). The mean subjective activity level percentage improved from 34 (range 20–50) pre-surgery to 81 (range 75–90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.

Download Full-text

Allograft reconstruction for symptomatic chronic complete proximal hamstring tendon avulsion

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-008-0588-9 ◽

2008 ◽

Vol 17 (1) ◽

pp. 19-23 ◽

Cited By ~ 16

Author(s):

Robert G. Marx ◽

Gregory Fives ◽

Samuel K. Chu ◽

Aaron Daluiski ◽

Scott W. Wolfe

Keyword(s):

Hamstring Tendon ◽

Allograft Reconstruction ◽

Proximal Hamstring ◽

Tendon Avulsion

Download Full-text

A Novel Technique for Proximal Hamstring Tendon Repair: High Reoperation Rate in a Series of 56 Patients

Advances in Orthopedic Surgery ◽

10.1155/2014/891875 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

William Blakeney ◽

Simon Zilko ◽

Wael Chiri ◽

Peter Annear

Keyword(s):

Functional Outcomes ◽

Assessment Tool ◽

Tendon Repair ◽

Return To Sport ◽

Hamstring Tendon ◽

Reoperation Rate ◽

Ischial Tuberosity ◽

Novel Technique ◽

Proximal Hamstring Rupture ◽

Proximal Hamstring

This investigation looked at functional outcomes, following a novel technique of surgical repair using table staples. Patients underwent surgery for proximal hamstring rupture with table staples used to hold the tendon reapproximated to the ischial tuberosity. Functional outcomes following surgery were assessed. We also used a combined outcome assessment measure: the Perth Hamstring Assessment Tool (PHAT). A total of 56 patients with a mean age of 51 (range 15–71) underwent surgery. The mean follow-up duration was 26 months (range 8–59 months). A large proportion of patients (21/56, 37.5%) required reoperation for removal of the staple. Patients that did not require removal of the table staple did well postoperatively, with low pain scores (0.8–2 out of 10) and good levels of return to sport or running (75.8%). Those that required removal of the staple had a significantly lower PHAT score prior to removal, 47.8, but this improved markedly once the staple was removed, with a mean of 77.2 (P<0.001). Although our patients achieved similar outcomes in terms of pain and function, we thought the reoperation rate was unacceptably high. We would not recommend proximal hamstring tendon repair using this technique.

Download Full-text

Reliability of MRI in Acute Full-thickness Proximal Hamstring Tendon Avulsion in Clinical Practice

International Journal of Sports Medicine ◽

10.1055/a-1306-0618 ◽

2020 ◽

Author(s):

Willem R. Six ◽

Constantinus F. Buckens ◽

Johannes L. Tol ◽

Frank F. Smithuis ◽

Mario Maas ◽

...

Keyword(s):

Decision Making ◽

Intraclass Correlation ◽

Treatment Decision ◽

Hamstring Tendon ◽

Full Thickness ◽

Rater Reliability ◽

Treatment Decision Making ◽

Proximal Hamstring ◽

Tendon Avulsion ◽

Tendon Retraction

AbstractIn clinically suspected acute full-thickness proximal hamstring tendon avulsions, MRI is the gold standard for evaluating the extent of the injury. MRI variables such as full-thickness free tendon discontinuity, extent of tendon retraction (>20 mm), and continuity of the sacrotuberous ligament with the conjoint tendon (STL-CT) are used in treatment decision-making. The objective was to assess the intra- and inter-rater reliability of these relevant MRI variables after acute full-thickness proximal hamstring tendon avulsion. Three musculoskeletal radiologists assessed MRIs of 40 patients with an acute full-thickness proximal hamstring tendon avulsion. MRI variables included assessment of free tendon discontinuity and continuity of the STL-CT and extent of tendon retraction. Absolute and relative intra- and inter-rater reliability were calculated. Intra- and inter-rater reliability for the assessment of tendon discontinuity was substantial (Kappa [ĸ]=0.78;0.77). For the retraction measurement of the conjoint and semimembranosus tendons, intra-rater reliability was moderate and poor (Intraclass correlation coefficient (ICC)=0.74;0.45), inter-rater reliability was moderate (ICC=0.73;0.57). Intra- and inter-rater reliability of the STL-CT continuity assessment was substantial and fair (ĸ=0.74;0.31). In conclusion, MRI assessment for full-thickness free tendon discontinuity is reliable. However, assessment of extent of tendon retraction and STL-CT continuity is not reliable enough to guide the treatment decision-making process.

Download Full-text

Proximal Hamstring Tendon Avulsion Resulting in Acute Posterior Thigh Compartment Syndrome

JBJS Case Connector ◽

10.2106/jbjs.cc.19.00585 ◽

2020 ◽

Vol 10 (2) ◽

pp. e0585-e0585

Author(s):

Jennifer Purnell ◽

Michael J. Monument ◽

Kelly Johnston ◽

Nicholas M. Desy

Keyword(s):

Compartment Syndrome ◽

Hamstring Tendon ◽

Posterior Thigh ◽

Proximal Hamstring ◽

Tendon Avulsion

Download Full-text

Abduction in Proximal Hamstring Tendon Avulsion Injury Mechanism—A Report on 3 Athletes

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000543 ◽

2017 ◽

Vol Publish Ahead of Print ◽

Author(s):

Anne D. van der Made ◽

Rolf W. Peters ◽

Claire Verheul ◽

Mario Maas ◽

Gino M. Kerkhoffs

Keyword(s):

Hamstring Tendon ◽

Injury Mechanism ◽

Avulsion Injury ◽

Proximal Hamstring ◽

Tendon Avulsion

Download Full-text

Proximal hamstring tendon avulsion treatment choice depends on a combination of clinical and imaging-related factors: a worldwide survey on current clinical practice and decision-making

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000292 ◽

2019 ◽

Vol 4 (4) ◽

pp. 175-180 ◽

Cited By ~ 2

Author(s):

Anne D van der Made ◽

Per Hölmich ◽

Gino M M J Kerkhoffs ◽

Vincent Gouttebarge ◽

Pieter D’Hooghe ◽

...

Keyword(s):

Decision Making ◽

Surgical Treatment ◽

Operative Treatment ◽

Sports Medicine ◽

Current Practice ◽

Hamstring Tendon ◽

Return To Sports ◽

Related Factors ◽

Proximal Hamstring ◽

Tendon Avulsion

ObjectivesTo evaluate current practice in the treatment of proximal hamstring tendon avulsions and identify decision-making preferences.MethodsAn invitation to an anonymous e-survey containing 32 questions was sent to 3475 members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the European College of Sports and Exercise Physicians (ECOSEP).ResultsWe received 403 (12%) unique responses with a completion rate of 79%. Participants were orthopaedic/trauma surgeons (90%), sports medicine physicians (7%) or physical therapists (2%). For 83% of the participants, the preferred treatment (ie, surgical or non-operative) depends on the individual case. Participants base their decision-making process on patient- and injury-related factors (decision modifiers). The five most frequently selected decision modifiers that support the choice for surgical treatment were diminished function (84%), neurological symptoms (74%), involved tendons (82%), tendon retraction on MRI (84%) and patient preference for surgery (78%). The majority prefer early surgical repair (<2 weeks after injury) to achieve highest functional outcome (63%) and ensure a low complication risk (61%). Suture anchors are used by 93% of the participants for tendon reattachment. Estimated recovery duration (ie, time to return to sports) was a median 12 weeks (IQR: 12–20) for non-operative treatment and 17 weeks (IQR: 12–24) for surgical treatment. Estimated reinjury risk was a median 25% (IQR: 10–31.5) and 10% (IQR: 5–20), respectively.ConclusionThis survey among experienced medical professionals has summarised current practice and identified treatment decision-making preferences. The typical surgical patient has a retracted (>2 cm) two-tendon avulsion (ie, common tendon and semimembranosus tendon), is unable to engage in sports or activities of daily life, reports sciatic symptoms and prefers surgical treatment. Surgery is thought to prolong recovery and decrease reinjury risk compared with non-operative treatment and is preferably performed early.Level of evidenceLevel V.

Download Full-text