Surgical Management of Chronic Incomplete Proximal Hamstring Avulsion Injuries

2020 ◽  
Vol 48 (5) ◽  
pp. 1160-1167
Author(s):  
Babar Kayani ◽  
Atif Ayuob ◽  
Fahima Begum ◽  
Natalia Khan ◽  
Fares S. Haddad
Keyword(s):  
Patient Satisfaction ◽  
Muscle Strength ◽  
Surgical Intervention ◽  
High Patient Satisfaction ◽  
Clinical Recurrence ◽  
Sporting Activity ◽  
Outcome Scores ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring

Background: Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence. Hypothesis: Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence. Study Design: Case series: Level of evidence, 4. Methods: This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery. Results: All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up. Conclusion: Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.

Surgical Repair of Distal Musculotendinous T Junction Injuries of the Biceps Femoris

2020 ◽  
Vol 48 (10) ◽  
pp. 2456-2464
Author(s):  
Babar Kayani ◽  
Atif Ayuob ◽  
Fahima Begum ◽  
Sandeep Singh ◽  
Fares S. Haddad
Keyword(s):  
Patient Satisfaction ◽  
Muscle Strength ◽  
Surgical Repair ◽  
Biceps Femoris ◽  
High Patient Satisfaction ◽  
Risk Of Recurrence ◽  
Sporting Activity ◽  
Acute Injuries ◽  
Outcome Scores

Background: Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported. Hypothesis: Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence. Study Design: Case series; Level of evidence, 4. Methods: This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery. Results: All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. Conclusion: Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.

Acute Surgical Repair of Complete, Nonavulsion Proximal Semimembranosus Injuries in Professional Athletes

2020 ◽  
Vol 48 (9) ◽  
pp. 2170-2177
Author(s):  
Atif Ayuob ◽  
Babar Kayani ◽  
Fares S. Haddad
Keyword(s):  
Patient Satisfaction ◽  
Muscle Strength ◽  
Functional Outcome ◽  
Surgical Repair ◽  
Low Risk ◽  
High Patient Satisfaction ◽  
Risk Of Recurrence ◽  
Sporting Activity ◽  
Outcome Scores

Background: Nonoperative management of proximal semimembranosus injuries is associated with prolonged periods of convalescence and high risk of recurrence. To our knowledge, the outcomes of acute surgical repair for complete, nonavulsion proximal semimembranosus injuries have not been previously reported. Hypothesis: Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries enables early return to sporting activity with low risk of recurrence. Study Design: Case series: Level of evidence, 4. Methods: This prospective single-surgeon study included 20 professional athletes undergoing acute primary surgical repair of complete, nonavulsion proximal semimembranosus injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardized postoperative rehabilitation program. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.6 months (range, 24.0-34.6 months) from date of surgery. Results: Of the 20 patients, 19 (95%) returned to their preinjury level of sporting activity. Mean ± SD time from surgical repair to full sporting activity was 11.9 ± 5.7 weeks. No patients had recurrence of the primary injury. At 3 months after surgery, patients had improved mean passive straight leg raise (71.5° ± 5.9° vs 31.1° ± 7.2°; P < .001); increased mean isometric hamstring muscle strength at 0° (83.8% ± 5.9% vs 48.4% ± 8.3%; P < .001), 15° (77.6% ± 6.0% vs 52.3% ± 14.7%; P < .001), and 45° (88.6% ± 5.4% vs 66.7% ± 13.1%; P < .001); higher mean lower extremity functional scores (64.8 ± 4.6 vs 34.4 ± 5.1; P < .001); and improved Marx activity rating scores (10.7 ± 1.6 vs 5.5 ± 2.0; P < .001) as compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. Conclusion: Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.

scholarly journals Predictors of Clinical Outcomes After Proximal Hamstring Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882371 ◽  
Author(s):  
Eric N. Bowman ◽  
Nathan E. Marshall ◽  
Michael B. Gerhardt ◽  
Michael B. Banffy
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Activity Level ◽  
Medical Comorbidities ◽  
Outcome Scores ◽  
The Mean ◽  
Tegner Score ◽  
Proximal Hamstring

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.

Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study

2021 ◽  
pp. 036354652110085
Author(s):  
Elsa Pihl ◽  
Kenneth B. Jonsson ◽  
Mida Berglöf ◽  
Nina Brodin ◽  
Olof Sköldenberg ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Assessment Tool ◽  
Patient Specific ◽  
Activity Limitations ◽  
Functional Tests ◽  
Functional Scale ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring ◽  
Lower Extremity Functional Scale

Background: The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. Purpose: To investigate 1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); 2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; 3) whether performance-based tests can discriminate between the injured and uninjured extremity; and 4) which activity limitations are perceived by patients several years after the injury. Study design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance–based tests (single-leg hop tests, single–step down test, and isometric and isokinetic strength tests). Results: A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong ( r = 0.832) and statistically significant ( P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (–0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). Conclusion: Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.

scholarly journals Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Petter Morten Pettersen ◽  
Joakim Eriksson ◽  
Hallgeir Bratberg ◽  
Lars Eldar Myrseth ◽  
Lise Grete Bjørnstad ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Patient Satisfaction ◽  
Open Arthrolysis ◽  
Follow Up Study

scholarly journals Suture Bridge Repair of Proximal Hamstring Avulsion: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 10-15
Author(s):  
Chad A. Edwards ◽  
Brian H. Goldman ◽  
Andrew Hadeed ◽  
Daniel Kalbac
Keyword(s):  
Technical Difficulty ◽  
Suture Bridge ◽  
Patient Morbidity ◽  
Surgical Fixation ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring ◽  
Anchor Fixation ◽  
Suture Bridge Technique ◽  
Severe Patient

Proximal hamstring avulsion injuries can represent a challenging problem and lead to severe patient morbidity if not treated appropriately. The most common method for acute surgical fixation involves the use of between two and five suture anchors in a variety of configurations. The five-anchor fixation has become the gold standard due to the increased biomechanical stability. However, the technique has also been criticized due to the need for greater exposure and technical difficulty. We report on an individual with a proximal hamstring avulsion injury who was managed with a modified approach, utilizing only three anchors in a suture bridge technique. The patient had good clinical outcomes at their 3-month follow-up visit, demonstrating this technique to be a viable option that is less technically demanding.

Hand Therapist Led Follow-up for Paediatric Hand Trauma – a Retrospective Study of 139 Closed Hand Injuries

2017 ◽  
Vol 19 (6) ◽  
pp. 531-536 ◽  
Author(s):  
Agata Marta Plonczak ◽  
Gordon J. McArthur ◽  
Nicola Goldsmith ◽  
Maxim Horwitz
Keyword(s):  
Patient Satisfaction ◽  
Hand Injuries ◽  
Complication Rates ◽  
Hand Trauma ◽  
Hand Therapy ◽  
High Patient Satisfaction ◽  
Patient Satisfaction Questionnaire ◽  
Satisfaction Questionnaire ◽  
Phalangeal Fractures

Background. Most hand injuries in children can be managed non-operatively and are associated with excellent outcomes. Whilst the majority of our patients are discharged to the care of hand therapists, there is no literature to support this protocol. Our aim was to ensure this is safe and effective practice. Material and methods. We conducted a retrospective analysis of all patients referred to our paediatric hand trauma clinic for closed injuries over a four month period between December 2014 and March 2015. Data related to demographics, injury pattern and clinical outcomes was recorded and analysed. A telephone interview with a patient satisfaction questionnaire was attempted with all patients discharged to the care of hand therapists. Results. 139 patients were seen in the study period, including 90 males and 49 females. Phalangeal fractures (39%), volar plate injuries (19%) and metacarpal fractures (16%) were the commonest causes of hand trauma. The majority of patients (88%) were managed non-operatively. 97 patients were discharged to hand therapy follow-up and we managed to contact 51 patients (53%). Fifty-one patients (100%) completed a patient satisfaction questionnaire. 100% of the parents were happy with the care, 96% were not disappointed they did not see a doctor and 96% denied any complications. Conclusion. 1. The majority of paediatric hand injuries can be managed non-operatively with excellent outcomes. 2. Hand therapy led follow-up is appropriate for a selected group of paediatric hand injuries. This study pro­ves that it is safe and effective for the majority of closed hand trauma, as illustrated by low complication rates. 3. Hand therapist led follow up for paediatric hand injuries is associated with high patient satisfaction.

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