Evolution of isokinetic strength and return to sport after proximal hamstring rupture without surgical repair: a retrospective series of cases.

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.

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Surgical Repair of Complete Proximal Hamstring Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/03635465020300051901 ◽

2002 ◽

Vol 30 (5) ◽

pp. 742-747 ◽

Cited By ~ 129

Author(s):

Kevin E. Klingele ◽

Peter I. Sallay

Keyword(s):

Tendon Rupture ◽

Surgical Repair ◽

Return To Sport ◽

Hamstring Tendon ◽

Nonoperative Treatment ◽

Activity Level ◽

Rare Injury ◽

Muscle Testing ◽

Postoperative Physical Therapy ◽

Proximal Hamstring

Background: Complete proximal hamstring tendon rupture is a rare injury associated with significant functional loss. Nonoperative treatment has proven inadequate in returning patients to their previous activity level. Purpose: We wanted to describe the outcome of primary surgical repair of the proximal hamstring tendon avulsion. Study Design: Retrospective cohort study. Methods: Between 1994 and 1999, 11 patients (4 women and 7 men) with an average age of 41.5 years (range, 21 to 51) had a diagnosis of complete proximal hamstring tendon rupture based on mechanism of injury, physical examination, and radiographic assessment. All underwent a single operation followed by standard postoperative physical therapy. At the latest follow-up (average, 34 months), patients completed a questionnaire regarding such outcome parameters as pain, function, leg control, stiffness, return to activity, and overall satisfaction. Results: Isokinetic muscle testing revealed an overall average of 91% return of hamstring muscle strength. Ten of 11 patients were satisfied with the result, and 7 of 9 athletically active patients were able to return to sport an average of 6 months (range, 3 to 10) after surgery. No difference between early and late repairs was identified in regard to functional outcome or return to sport. Conclusions: Satisfactory results can be achieved with both early and late hamstring tendon repairs in a majority of cases with surgical repair.

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Is Brace Immobilization Needed Following Surgical Repair Of Proximal Hamstring Tears?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00418 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0041

Author(s):

Lionel E. Lazaro ◽

Michael B. Banffy

Keyword(s):

Surgical Repair ◽

Weight Bearing ◽

Healing Process ◽

Return To Sport ◽

Knee Extension ◽

Partial Weight Bearing ◽

Hamstring Injuries ◽

Hip Flexion ◽

Partial Weight ◽

Proximal Hamstring

Objectives: Braces are commonly used in Orthopaedic to protect repaired tissue from excessive stress that can compromise the healing process. Some of these braces can become a nuisance, especially the ones commonly used following proximal hamstring repairs. The idea is to limit hip flexion and knee extension to avoid stretching of the hamstrings. However, this immobilization creates discomfort and limitation during the basic daily needs, possibly compromising patient satisfaction. We hypothesis that proximal hamstring repairs can be safely managed, without brace immobilization and allowing partial weight bearing immediately after surgery, and result in excellent outcomes with minimal complications. Methods: We identify 57 patients that underwent surgical repair of proximal hamstring injuries. The repairs were fixed using suture anchors, and the same surgical technique were performed by a single sport medicine fellowship trained Orthopaedic surgeon. During the postoperative period the patient were allowed to bear partial weight with the assistance of crutches for 6 weeks. At the fourth week, light stretches begin with assistance of the physical therapist. Brace immobilization is not utilize at all, instead detail instruction are provide to the patient to avoid simultaneous hip flexion and knee extension. Subjective outcome measures included: the single assessment numeric evaluation (SANE); I-Holt 12 and KJOC hip scores. Clinical data was obtained from the electronic medical records. Results: Mean patient age was 52 years (range 29-69). The injury was chronic (> 6 weeks) in 55% of the patients. Mean length of follow-up was 32 months ( range 14-60). One patient failed repair, requiring revision surgery. The average SANE score were excellent at 97points, and representing a 43 points increase from the preoperative assessment. Similarly, the mean score for the I-Holt 12 and KJOC hip scores were very good with 99 and 83 points, respectively. In 68% of the patient the injury was sport related, and they all return to sport at an average of 7 months. Conclusion: A post-operative protocol that included immediate partial weight bearing and does not utilized immobilization brace can result in excellent subjective outcomes, high rate to return to sport in a timely matter and low failure rates. Based in our findings, brace immobilization following surgical repair of proximal hamstring appear to be excessive and may not provide additional benefit.

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Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report

HSS Journal ® ◽

10.1007/s11420-018-9620-x ◽

2018 ◽

Vol 14 (3) ◽

pp. 302-306 ◽

Cited By ~ 2

Author(s):

Patrick S. Buckley ◽

Christopher C. Dodson

Keyword(s):

Case Report ◽

Proximal Hamstring Rupture ◽

Proximal Hamstring

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Variability in Rehabilitation Protocols after Superior Labrum Anterior Posterior Surgical Repair

Kansas Journal of Medicine ◽

10.17161/kjm.vol14.15286 ◽

2021 ◽

Vol 14 ◽

pp. 243-248

Author(s):

Christina Hermanns ◽

Reed Coda ◽

Sana Cheema ◽

Matthew Vopat ◽

Armin Tarakemeh ◽

...

Keyword(s):

Patient Outcomes ◽

Surgical Repair ◽

Return To Sport ◽

Return To Sports ◽

Biceps Tenodesis ◽

Slap Repair ◽

Rehabilitation Protocols ◽

Google Search ◽

Improve Patient ◽

Anterior Posterior

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded. Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.

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Return to Sport After Surgical Management of Proximal Hamstring Avulsions

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000688 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 3

Author(s):

Ryan P. Coughlin ◽

Jeffrey Kay ◽

Ajaykumar Shanmugaraj ◽

Muzammil Memon ◽

Leen Naji ◽

...

Keyword(s):

Surgical Management ◽

Return To Sport ◽

Proximal Hamstring

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Proximal Hamstring Injuries: Review of Operative and Nonoperative Management

The Journal of Hip Surgery ◽

10.1055/s-0038-1676285 ◽

2018 ◽

Vol 02 (04) ◽

pp. 176-188

Author(s):

Kyle Duchman ◽

Ned Amendola ◽

Joseph Buckwalter V

Keyword(s):

Surgical Repair ◽

Nonoperative Management ◽

Current Evidence ◽

Surgical Indications ◽

Endoscopic Repair ◽

Hamstring Injuries ◽

Partial Tears ◽

And Function ◽

Proximal Hamstring ◽

Repair Techniques

AbstractWhile uncommon, proximal hamstring injuries can result in significant pain and dysfunction, while also posing considerable treatment dilemmas due to the spectrum of injury that exists. Recent literature suggests that outcomes are improved with acute surgical repair of complete proximal hamstring avulsions, highlighting the importance of timely management of these unique injuries. While chronic repair or reconstruction can result in predictable improvements in pain and function postoperatively, the results are less predictable than acute surgical repair. Nonoperative management should be considered as the initial treatment strategy for patients with proximal hamstring tendinopathy or partial tears, as delayed surgical intervention in this setting has not been shown to significantly affect outcomes. Although current evidence is limited, evolving therapeutic techniques, including biologic injections and endoscopic repair techniques, need to be carefully evaluated to determine their role moving forward. This review aims to provide updated information on the relevant anatomy, mechanism of injury, diagnosis, and management of proximal hamstring injuries, with a specific focus on surgical indications, techniques, and outcomes.

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