Mid-term functional outcome and return-to-sports activity following surgical refixation of proximal hamstring tendon ruptures

Background: Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness. Methods: The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury. Results: Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture. Conclusions: Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211043097 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110430

Author(s):

Raymond Best ◽

Anorte Meister ◽

Malin Meier ◽

Jochen Huth ◽

Ulrich Becker

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Predictive Factors ◽

Hamstring Tendon ◽

Patient Reported ◽

Duration Of Surgery ◽

The Mean ◽

Concomitant Factors ◽

Proximal Hamstring ◽

Tendon Avulsion

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.

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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.

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Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature

British Journal of Sports Medicine ◽

10.1136/bjsm.2004.015719 ◽

2005 ◽

Vol 39 (8) ◽

pp. 569-572 ◽

Cited By ~ 105

Author(s):

J Chakravarthy

Keyword(s):

Surgical Repair ◽

Hamstring Tendon ◽

Review Of The Literature ◽

Tendon Ruptures ◽

Proximal Hamstring

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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.

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Clinical Outcome and Return to Competition after Microfracture in the Athlete’s Knee

Cartilage ◽

10.1177/1947603510366576 ◽

2010 ◽

Vol 1 (2) ◽

pp. 113-120 ◽

Cited By ~ 29

Author(s):

Kai Mithoefer ◽

Thomas J. Gill ◽

Brian J. Cole ◽

Riley J. Williams ◽

Bert R. Mandelbaum

Keyword(s):

Functional Outcome ◽

Cartilage Repair ◽

Return To Sport ◽

Sports Participation ◽

Return To Sports ◽

Sports Activity ◽

Systematic Analysis ◽

Duration Of Symptoms ◽

Athletic Competition ◽

Return To Competition

Microfracture is frequently used for articular cartilage repair in athletes. This study aimed to define the strength and weaknesses of this minimally invasive cartilage repair technique in the athletic population in an effort to optimize indications, functional outcome, and athletic participation after microfracture in the athlete’s knee. A systematic analysis of original studies using microfracture in athletes was performed. Functional outcome was assessed by activity outcome scores, ability to return to sports participation, timing of the return to sport, level of postoperative sports activity, and continuation of athletic competition over time. Thirteen studies describing 821 athletes were included in the analysis with an average follow-up of 42 months. Good or excellent results were reported in 67% of athletes with normal International Knee Documentation Committee (IKDC) scores in 80% and significant increase of Lysholm scores, Tegner activity scores, and Knee injury and Osteoarthritis Outcome Score (KOOS) sports subscales. Return to sports was achieved in 66% at an average of 8 months after surgery, with return to competition at the preinjury level in 67%. Forty-nine percent of athletes continued to compete without change in level of play, while decreasing function was observed in 42% after 2 to 5 years. Athlete’s age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology affected sports activity after microfracture. Microfracture improves knee function and frequently allows for return to sports at the preinjury level, but deterioration of athletic function occurs in some patients. Several independent factors were identified that can help to optimize the return to athletic competition after microfracture in the athlete’s knee.

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