Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons

Abstract

Nonoperative treatment of acute or chronic complete ruptures of the proximal hamstring tendons leads to functional impairment in sports activities. The objective of the study was to evaluate the functional status after primary and delayed surgical treatment including objective (isokinetic hamstring and quadriceps muscle testing, hamstring flexibility) and subjective parameters (overall satisfaction, postoperative sports level). A total of eight patients (six male, two female) with an average age of 40.0 years (range 23-60) were treated operatively by refixation of the ruptured tendons in anatomical position using a suture anchor system. Six patients were treated within 3 weeks after trauma, while two patients were operated after delayed diagnosis of more than 2 months. The average clinical follow-up was 33.3 months (range 12-59). Overall, at minimum follow-up of 20 months, all patients were satisfied with the functional outcome and would undergo operative treatment again. At follow-up, seven patients could return to their preinjury sports level. In two patients, however, we noticed a delayed return to preinjury sports level of more than 24 months. The peak torque of the operated hamstrings in isokinetic muscle testing was 88.3% (range 62.9-113.8), as compared to the contralateral extremity. The ratio of hamstring to quadriceps muscle strength was on average 0.55 (range 0.44-0.66; injured side) versus 0.61 (range 0.52-0.68; uninjured side). Measurement of hamstring flexibility showed no difference to the contralateral hamstrings. In cases of timely diagnosis, surgical treatment is the standard treatment for complete ruptures of the proximal hamstring tendons in patients with ambitions inclined toward sports. The suture anchor system implements an elegant and effective technique for the treatment of such lesions.

Self-Reported and Performance-Based Functional Outcomes After Surgical Repair of Proximal Hamstring Avulsions

“…9,18,27 The mean peak torque of the injured leg for knee flexion was 84% of the uninjured, while the mean total work of the injured leg for knee flexion was 81%. Eighteen (60%) patients had a LSI of < 85% for peak torque hamstring strength.…”

“…13,14,26,36 Return to preinjury level of sport and patient satisfaction are usually used as main outcomes after undergoing repair of proximal hamstring tendon rupture. 9,28,37,41 Isokinetic muscle strength has been used as a performance-based outcome, showing a mean limb symmetry index (LSI) between 80% and 95%, although most of the studies have included few patients. 9,18,27,36 Only 2 previous studies have assessed performance-based outcomes after surgical treatment in a larger population (n > 20).…”

“…9,28,37,41 Isokinetic muscle strength has been used as a performance-based outcome, showing a mean limb symmetry index (LSI) between 80% and 95%, although most of the studies have included few patients. 9,18,27,36 Only 2 previous studies have assessed performance-based outcomes after surgical treatment in a larger population (n > 20). 7,41 The patients' subjective feeling of confidence is important for a return to their preinjury level of activity.…”

Acute Proximal Hamstring Rupture

“…The small numbers of published studies contain both acute and chronic tears and include a relatively small number of patients. [2][3][4][5][6][7] The findings in these studies are summarized in table 1.…”

“…[5] MRI was used to confirm the diagnosis in all cases. Return to sports activities was allowed after 6-8 months.…”