Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair

Sandmann, Gunther H.; Hahn, Daniel; Amereller, M.; Siebenlist, Sebastian; Schwirtz, Ansgar; Imhoff, Andreas B.; Brucker, Peter U.

doi:10.1055/s-0035-1564170

Cited by 36 publications

(21 citation statements)

References 32 publications

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“…All studies performed proximal HT repair with patients in the prone position and the affected limb partially flexed at the knee to avoid tension on the HT. In 6 studies 3,4,6,13,21,23 (37.5%), a transverse incision was made at the gluteal crease, and the caudal edge of the gluteus maximus was identified and retracted proximally to expose the injured HT. Six studies 1,8,15,16,18,20 (37.5%) performed HT repair with a vertical incision starting from the ischial tuberosity extending 5 to 15 cm distally, depending on the size of the patient, and 1 study 25 (6.3%) used a transverse incision for acute injuries (<6 months) and a vertical incision for chronic injuries (>6 months).…”

Section: Resultsmentioning

confidence: 99%

Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Belk

Kraeutler

Mei-Dan

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

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Section: Resultsmentioning

confidence: 99%

Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Belk

Kraeutler

Mei-Dan

et al. 2019

Orthopaedic Journal of Sports Medicine

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mentioning

confidence: 99%

“…Surgical management of proximal tendon avulsions has since become the standard, and good results after open repair have been consistently reported, supporting surgical management of this type of hamstring injury. 2,3,5,6,27,28 Currently, most proximal hamstring repairs are performed using an open technique through an 8-cm incision in the gluteal crease with dissection and elevation of the inferior border of the gluteus maximus. 1,5,21,22,31 The anatomy of the proximal hamstring tendon origin and pertinent surrounding structures has been described in reference to open surgical repairs.…”

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confidence: 99%

Portal Placement and Biomechanical Performance of Endoscopic Proximal Hamstring Repair

et al. 2019

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Background: Proximal hamstring tendon avulsions are debilitating and commonly cause pain, weakness, and functional limitations. Open surgical repair has been the standard, but improved endoscopic techniques have enabled proximal hamstring fixation with decreased risk of infection and numbness, without the morbidity of a large incision. Purpose/Hypothesis: The purpose was to (1) describe pertinent anatomy surrounding the proximal hamstring origin in relation to 4 endoscopic portal sites and (2) test for biomechanical differences between open and endoscopic repair. It was hypothesized that (1) endoscopic proximal hamstring repair is efficacious with respect to commonly used portals and (2) there is no biomechanical difference between open and endoscopic techniques. Study Design: Descriptive and controlled laboratory study. Methods: Proximal hamstring ruptures were simulated endoscopically in 10 fresh-frozen human cadaveric pelvis specimens. Endoscopic repair was then completed on 1 limb from each specimen through 4 portals. After repair, each specimen was dissected in layers and measurements from portal tracts to pertinent anatomy were obtained. Open repair was performed on all contralateral limbs, followed by cyclical biomechanical tensile testing to failure of both the open and endoscopically repaired hamstring tendons to assess failure load and local tissue strain. Results: On average, no portal tract was closer than 2.0 cm to the sciatic nerve or inferior gluteal neurovascular bundle. Anatomic landmarks were identified that could improve the reproducibility and safety of the procedure. Biomechanical testing revealed no differences between the open and endoscopic repair techniques for any measured parameter. Conclusion: This study supports the safety and efficacy of endoscopic proximal hamstring repair through anatomic and biomechanical analyses and helps establish reproducible and recognizable landmarks that define a safe working zone. Clinical Relevance: This study maps the anatomic landscape of the proximal hamstring as encountered endoscopically and demonstrates equivalent biomechanical strength of endoscopic proximal hamstring repair, supporting this technique’s safety and efficacy.

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“…Surgical repair of hamstring avulsions is associated with good functional outcomes, particularly when the repair occurs acutely. 3,6,12,13 The intimate association of the hamstring muscle group and the sciatic nerve means that simultaneous injury to the sciatic nerve can occur. There are case reports of distal sciatic nerve symptoms that develop both acutely and chronically after hamstring avulsion.…”

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confidence: 99%

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair

Wilson

Spinner

Mohan

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery.Purpose:To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve–related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively.Results:The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve–related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients’ sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive.Conclusion:Sciatic nerve–related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment.

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Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair

Cited by 36 publications

References 32 publications

Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Portal Placement and Biomechanical Performance of Endoscopic Proximal Hamstring Repair

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair

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